The latest on California politics and government

June 6, 2014

Lobbyist Charles Bacchi will take over as president of the California Association of Health Plans when its current leader, former state Sen. Patrick Johnston, retires at the end of this year, the organization announced Friday.

Bacchi has worked for the group that advocates for health insurers for the last eight years, first as vice president of government relations and more recently as executive vice president. He has lobbied for insurance plans as California implemented the federal Affordable Care Act and expanded Medi-Cal.

"I am excited to work with California's health plan leaders on improving our health care system, delivering affordable coverage, and bolstering our partnership with the state of California," Bacchi said in a statement.

Johnston, who served in the Legislature from 1981 to 2000, is retiring after five years at the helm of the association. In a statement, he said:

"I have been fortunate to have had a fulfilling and enriching career engaged in public policy issues confronting California."

PHOTO: Former state Sen. Patrick Johnston is president of the California Association of Health Plans.

June 3, 2014

A ballot measure aimed at protecting a multi-billion-dollar stream of federal revenue for California hospitals from legislative interference apparently won't appear on the November ballot.

The California Hospital Association said Tuesday that random sampling of signatures for its ballot measure by election officials indicate that it would require a full signature count to qualify – if it does – and "based on this information, it is not likely that the ballot measure will qualify by the June 26 deadline to appear on the November 4, 2014 general election ballot."

The organization submitted 1.2 million signatures and needs 807,615 valid registered voter names to make the ballot, but the random sampling indicates it won't meet the threshold without a full count.

The proposed measure is a constitutional amendment that would require voter approval of any change in a special fee that's been levied on hospitals since 2009 to provide matching funds for about $2 billion year in federal funds to treat low-income patients.

The hospitals agreed to the fee as the state struggled to balance its budget each year and want it to continue indefinitely because they receive much more in extra revenue than the fee costs them.

If a full signature count qualifies the measure, it would appear on the ballot in 2016. Meanwhile, the fee is likely to continue.

Through March, proponents' campaign committee had raised more than $51 million and spent $27.1 million – including $1.6 million for signature gatherers and $25 million to reserve advertising time for a planned fall campaign. The committee had $24 million on hand as of March 31.

PHOTO: Angela Torrens of Rocklin signs a petition in front of the Bel Air grocery store in Rocklin in September 2007 to qualify a tribal-casino referendum for the ballot. The Sacramento Bee/Randall Benton

May 23, 2014

A bill to extend subsidized health benefits to undocumented immigrants stalled in the state Senate on Friday, but could be revived if its supporters identify a way to pay for the expansion.

Senate Bill 1005 aims to close a gap in the federal health care overhaul, which only makes insurance plans available to those in the country legally. Authored by Sen. Ricardo Lara, D-Bell Gardens, the measure would open Medi-Cal to undocumented immigrants as well as create a marketplace for new plans.

California counties currently provide health care to undocumented immigrants, but the coverage varies greatly among counties.

Health advocates contend the legislation is needed to fully achieve the promises of the federal Affordable Care Act in California. Sen. Kevin de León, D-Los Angeles, and chairman of the upper house's fiscal committee, described a "two-tiered" system that discriminates against millions of people that but "for lack of paperwork are Americans."

"SB 1005 is a necessary measure, but we need to continue to find responsible funding sources so that we don't already over-strain our safety net, and make sure it doesn't come apart," de León said.

Lara and advocates were given the summer to develop a funding mechanism for the expansion. At the hearing, Lara said he respected the decision.

"Expanding healthcare for all Californians is not a question of if but ... a matter of when," he said.

PHOTO: Sen. Ricardo Lara is joined, left to right, by UC Davis student Ana Maciel, UC President Janet Napolitano, Sacramento State student Deisy Caro and Sacramento State President Alexander Gonzalez at the State Capitol on April 9. The Sacramento Bee/Paul Kitagaki Jr.

May 1, 2014

Establishing a system of subsidized health insurance for undocumented immigrants in California won conceptual approval late Wednesday from a state Senate committee, but its author acknowledged that he doesn't yet have an "appropriate funding mechanism."

The measure, Senate Bill 1005, would place the new system under control of Covered California, the state's provider of health insurance under the federal Affordable Care Act, and offer similar benefits.

California's estimated three million undocumented immigrants are now excluded from ACA coverage, which includes billions of dollars in federal subsidies, and covering them, as Sen. Ricardo Lara, D-Bell Gardens, envisions, would require many millions of dollars in underwriting funds, but no precise cost estimate has been made.

Lara believes that his proposed system could enroll about a million immigrants, and told the committee he has a team of academic experts working on the financing issue and hopes to have something in hand before his measure reaches the Senate floor.

The Senate Health Committee approved SB 1005 after hearing from dozens of immigrant rights and health care groups. The only opposition came from Californians for Population Stabilization, which opposes illegal immigration.

"California continues to lead where the federal government is failing to act. While we've made enormous strides to reduce California's uninsured population with the implementation of the Affordable Care Act, we won't have a truly healthy state until everyone has access to quality, affordable coverage," Lara said in a statement after the committee action.

PHOTO: People who attended an Aug. 30. 2012 health fair in Sacramento, sponsored by the Mexican consul general, had their blood checked for cholesterol and glucose levels. The Sacramento Bee/Randy Pench.

April 21, 2014

Good Friday was a good day for opponents of a ballot initiative to regulate health insurance prices.

The coalition of doctors, hospitals and insurance companies last week reported collecting nearly $24 million from Blue Shield of California and Kaiser Foundation Health Plan. Half of the money was listed as loans to the campaign.

The contributions follow more than $13 million in donations from WellPoint and Anthem Blue Cross last year. Opponents of the effort argue it will drive up the cost of care in California.

"The sponsors drafted a flawed, deceptive measure with language buried in the fine print that will line their pockets at the expense of consumers, who will face higher health care costs," said Robin Swanson, a spokeswoman for Californians Against Higher Health Care Costs. "Our coalition of doctors, hospitals, health plans and employers will have the necessary resources to inform voters across the state about these flaws and the real reason the special interests behind this measure spent millions to put in on the ballot."

Other opposing donors include Health Net and the California Association of Health Plans.

Advanced by Consumer Watchdog, the November ballot measure would allow the state's elected insurance commissioner to deny health premium increases they deem excessive. California regulators based on a previous statewide initiative already have the power to deny automobile, property and casualty insurance rate increases.

Jamie Court, the initiative proponent and president of Consumer Watchdog, said the group is betting voters will see through the money. A campaign statement coming due will show the group has about $150,000 on hand to spend from its three commitees, he said.

"I don't think any amount of money can deny they are unjustifiably raising rates," Court said. "The fact that they are spending so much will signal to Californians just how important and significant this inititive is."

PHOTO: Jamie Court, president of Consumer Watchdog. Photo by Kent A McInnis Jr.

April 17, 2014

Citing a large influx of customers in the final weeks, California officials announced Thursday that more than 3 million people enrolled in health insurance coverage or Medi-Cal, capping an opening period that saw the state emerge as an example for the rest of the nation.

Covered California said 1.39 million customers enrolled in exchange plans, including 205,685 after officials granted a two-week extension through April 15. Some 1.2 million of the customers are eligible for federal subsidies.

"We are proud of what California has achieved, but recognize this is only the beginning of a long road of expanding affordable coverage to all Californians," Lee said in announcing the tallies.

Of the 1.9 million people to enroll in Medi-Cal through March, 1.1 million came by way of the state exchange and county officials. Despite website and phone troubles, more than 40 percent of exchange customers picked coverage though the website. Overall figures since Oct. 1, 2013 far exceeded the exchange's initial projections, officials said.

Enrollment among Latinos and young people - essential groups that earlier eluded the exchange - improved in recent months as officials dedicated more resources to marketing and community engagement.

Latinos constituted 30 percent of the sign-ups in March and April, pushing the final figure to 28 percent. Similarly, enrollment among customers aged 18 to 34 ticked up to 29 percent. Federal officials have said they need 40 percent of enrollees to be under 35.

The exchange reported meeting its projection among African-Americans and more than doubling its base goal for Asian-Americans.

PHOTO: Michael Wilson, left, a certified Covered California agent helps Jose and Laura Gomez of Sacramento with their choice for insurance coverage at the SEIU union hall on March 31, 2014. The Sacramento Bee/Randy Pench

April 15, 2014

In less than three months, healthcare networks and individual hospitals have pumped more than $51 million into a proposed ballot measure meant to lock up revenue from a Legislature-approved fee on acute-care hospitals.

The measure would limit lawmakers' ability to change or repeal the "Medi-Cal Hospital Reimbursement Act," which lawmakers passed last year as SB 239. With hospitals' backing, the law continued a hospital quality-assurance fee first passed in 2009 through 2016.

The money helps pay for children's health coverage, Medi-Cal, and other programs. Even though hospitals pay the fee, matching federal money means a net benefit of $10 billion for the hospital industry from 2014 through 2016, according to a legislative analysis.

The proposed ballot measure would strip the Jan. 1, 2017 sunset date from the law. It also would require voter approval for any changes to it. And any attempt to repeal the law entirely would need a two-thirds vote of the Legislature.

In addition, the proposed initiative declares that revenue from the law and interest doesn't count against the state's school-funding guarantee.

March 31, 2014

More than 150,000 people have signed up for Covered California health insurance in the past week, bringing total state enrollment to roughly 1.2 million and slowing the online portal to a crawl as residents rush to beat a midnight deadline.

Meanwhile, Medi-Cal has enrolled approximately 1.5 million new members though mid-March.

Covered California Executive Director Peter V. Lee said the number of household accounts opened since last week totaled about 390,000, including 123,787 on Saturday and Sunday.

"We are seeing more accounts open than any day ever. And we are seeing that today with a huge amount of interest on the site, and it is causing the website to be quite slow," Lee said.

The exchange is working on several ways to accommodate the spike. With about 12 hours left in the first open-enrollment period, the state exchange is placing a high priority on allowing people to begin their applications and then return to complete them by April 15.

Some customers will get a "congratulations" note telling them they have started the application process but because of the high demand they will not be able to finish the process Monday, Lee said. Officials have switched off the "preview plan" tool because of lagging performance but will retain the "shop and compare" function.

Despite hiring on 250 additional people, wait times at customer service call centers averaged 42 minutes in the last week and about 70 minutes over the weekend. A number of enrollment events are taking place across the state, including in Sacramento, Oakland and Los Angeles.

The SEIU-United Healthcare Workers West union is hosting two "enroll-a-thons" Monday at its Sacramento office, 1911 F St., from 7 a.m. to midnight. For details, call ( 888) 920-4517. See video below.

Affordable Care Act sign-ups: Where to get help before March 31 deadline

Covered California's website and call centers also will have extended hours, from 8 a.m. to 8 p.m.

In addition, consumers can call a licensed insurance agent or go to health care websites, such as eHealthInsurance.com, which is extending its call center hours through midnight Monday (800) 977-8860.

What You'll Need: Whether enrolling by phone, online or in person, every individual family member should have: proof of identity (photo ID, driver's license, passport); proof of address (utility bill or postmarked mail); income information (two paystubs or recent tax return); proof of citizenship (birth certificate, permanent resident card, or naturalization certificate). Each person enrolling also must provide date of birth, Social Security number and ZIP code.

PHOTO: Karla Sanchez, 31, of North Highlands holds her son, Luis Marcial, 4, who naps in her arms while she makes her choice for insurance coverage at the SEIU union hall on Monday. The Sacramento Bee/Randy Pench

March 24, 2014

Consumer Watchdog submitted more than 800,000 signatures Monday for a ballot measure that would modify the state's $250,000 cap on pain and suffering injuries in medical malpractice cases, touching off what promises to be a fierce battle with medical providers and their insurers.

The cap (known as MICRA) was signed by Gov. Jerry Brown in 1975, during the first year of his first governorship, and has been the subject of political maneuvering ever since between the medical industry and Consumer Attorneys of California, whose members file and pursue personal injury cases.

Most recently, with signatures being collected for the measure, Senate President Pro Tem Darrell Steinberg has been trying to work out a legislative compromise on the long-burning issue, but that effort apparently failed. And once the 830,000 signatures were submitted, the measure, if qualified, could not be removed from the November ballot.

"My suggested compromise was to raise the MICRA cap on damages due to medical malpractice from $250,000 to $500,000," Steinberg said in a statement. "A cap of $500,000 is far below the rate of inflation since MICRA became law 39 years ago. That number is a reasonable compromise that fairly compensates injured patients without significant increases in medical costs.

"If one side says no, it's a terrible missed opportunity. An initiative battle is costly and uncertain, and will damage the reputation of two fine professions. This issue cries out for a legislative solution, and what I'm offering is a conservative increase that's fair to injured patients as well as the medical and legal communities."

Consumer Watchdog, a Southern California organization that has long been allied with the trial lawyers, submitted the petitions in Los Angeles and staged a news conference at which families of malpractice victims decried the limit. One was Robert Pack, a Bay Area businessman whose two children were run over and killed by a driver who had been overprescribed with drugs by doctors.

Pack, who is the out-front spokesman for the measure, said not only should the cap be lifted as a deterrent to malpractice but the proposal's other provisions, requiring drug testing of doctors and compelling them to check a registry of drug addicts to curb over-prescription of drugs, are needed to stop what was called a "patient safety crisis."

The medical and insurance industries have been gearing up to oppose the Consumer Watchdog-Pack measure and say they are ready to spend more than $30 million on a campaign against it. They contend that the cap has held down malpractice insurance rates, which also hold down medical costs, and that the drug-testing provisions of the measure are unneeded and mask a measure that would put more money in the pockets of lawyers.

Update: Amended at 11:50 to include Steinberg statement.

PHOTO: A West Sacramento billboard highlights the looming ballot fight to overturn the state law capping pain-and-suffering damages in medical negligence cases. Photo courtesy of Consumer Watchdog.

March 13, 2014

The number of Californians enrolling in coverage through the state's new health insurance marketplace reached 923,832 through Sunday, officials said.

Covered California announced Thursday that 762,174 of the 880,000 residents to select plans through the end of last month were eligible for federal subsidies, surpassing projections for the entire first enrollment period that runs through March 31.

Another 1.34 million are likely to be eligible for Medi-Cal coverage.

"We are rolling toward a strong finish, but we're here to encourage consumers to not wait until March 31 to join the millions of Californians who have already found their pathway to affordable coverage, and enroll today," Executive Director Peter V. Lee said in a prepared statement. "We're building momentum on many fronts: among Latinos, among young people and in communities throughout the state. Californians' desire for health insurance to protect themselves and their families is building on friends telling friends and family telling family."

About 85 percent of all enrollees have paid their first month's premium, Lee added.

PHOTO: A Sacramento State student looks at a pamphlet with information on Covered California on Thusrday, October 16, 2013. The Sacramento Bee/Hector Amezcua.

March 5, 2014

State Sen. Ted Gaines has filed a lawsuit against the state health insurance exchange, claiming agency officials exceeded their power when they instructed participating health insurance companies to terminate existing policies for hundreds of thousands of Californians.

The lawsuit, filed in Los Angeles County Superior Court, seeks to prevent the exchange from requiring cancellation of policies that do not comply with the provisions of the federal law. That, presumably, would allow insurance companies to continue offering the plan.

"A lot of people have policies that have not changed, and they've had them in place for decades, and now they are out," said Gaines, R-Rocklin, a candidate for state insurance commissioner. "They were forced out of the plan into something that was more expensive and in many cases with higher deductibles. There are some real abuses."

Gaines' lawsuit also alleges the exchange is wasting taxpayer dollars on public relations.

Anne Gonzales, a spokeswoman for the exchange, declined to address Gaines' claims.

"Covered California hasn't received service in this matter," she said. "When it does, our legal team will review the complaint."

The exchange last fall refused to give insurance companies more time to end individual policies that don't conform to the federal heath care overhaul. The cancellations applied to individual plans purchased after passage of the health law.

The decision came shortly after President Barack Obama in November allowed states to extend millions of canceled insurance policies for one year amid uproar over his statements that customers who like their plans could keep them.

Among the most vocal critics of the exchange at the time was state Insurance Commissioner Dave Jones, a Democrat. Jones also used the threat of legal and other action to persuade two insurance industry giants to delay terminating scores of plans across the state.

Still, Gaines, the president of Gaines Insurance in Roseville, argues Jones did not do enough to prevent the plans from being canceled.

His lawsuit also requests an order from the court to halt exchange spending on things like infomercials and public relations. Specifically, it identifies as unrelated to the exchange's mission allocating $1.3 million for a six-hour infomercial featuring health and fitness guru Richard Simmons, more than $10 million on a contract with the public relations firm Weber Shandwick and "untold funds" on a contract with Ogilvy Public Relations.

PHOTO: Senator Ted Gaines, R-Rocklin, during session in the Senate chambers in Sacramento on March 11, 2013. The Sacramento Bee/Hector Amezcua.

February 28, 2014

Computer problems that darkened Covered California's website last week will force as many as 14,500 customers with partially completed applications to either resubmit the changes or begin a new request, officials at the health exchange said Friday.

Overall, about 37,000 Californians were affected by a software malfunction that led officials to ground their enrollment portal for five days. Those who submitted updates between Feb. 17 and Feb. 19 may have to start over.

The state exchange plans to follow up with the customers to restore their information. Customers must finish their enrollment by March 15 for coverage to begin April 1. The deadline for the first open enrollment period is March 31.

"They also can call in and we can give them assistance if they want to do it by phone," said Anne Gonzales, a spokeswoman for Covered California.

While personal data was not compromised during the outage, some of the data must still be recovered and checked for accuracy.

The exchange was forced to take offline the enrollment function of its website on Feb. 19 after the malfunction rendered some customer pages unreadable. The problems were discovered following scheduled 24-hour maintenance beginning at 1 a.m. Feb. 17.

All services were restored about 4 a.m. Monday.

About 6,500 customers that completed applications and selected plans between Feb. 17 and Feb. 19 are affected but need not worry, officials said. The information will be fully restored and processed by the health insurance plans.

Another 16,000 applicants likely eligible for Medi-Cal will have their paperwork restored and processed by counties. They should call their county human services agency with any questions, officials said.

February 21, 2014

The state health insurance exchange's online enrollment portal remains down because of a software malfunction that has dogged consumers.

Covered California took the enrollment function offline Wednesday afternoon, and officials initially said engineers hoped to have the service restored Friday.

That target was later postponed until Saturday.

Officials did not go into detail about what's plaguing the website, but said the breakdown was making it harder for people to enroll. The website still remains accessible to people searching for information about health plans and using the "Shop and Compare Tool" to find health care coverage in their regions.

About 828,600 people enrolled in health coverage via the state health insurance exchange through the first two weeks of February, far outpacing other states with marketplaces.

Still, this is not the first time the exchange has struggled with technology glitches. It experienced computer and phone troubles while accepting applications to train health insurance agents, and then with the launch of CoveredCA.com's sign-up portal.

Last month, top officials acknowledged the level of service over the first three months was "completely unacceptable." They said they would try to improve the system's performance for the enrollment period ending March 31.

They endeavored to answer 80 percent of their calls within 30 seconds. But internal reports show only a small fraction of the thousands of calls into its service centers met that goal.

Earlier this month, officials were forced to temporarily discontinue the exchange's provider directory after complaints about errors in the physician list. The directory of doctors and hospitals was posted shortly after the exchange opened for business Oct. 1, but was temporarily taken down within a day of its release because it was plagued by inaccuracies and sluggish performance.

At the time, Executive Director Peter V. Lee said it was put online prematurely.

February 19, 2014

Some 828,638 Californians enrolled in health coverage via the state health insurance exchange through the first two weeks of February, officials said Wednesday.

The tally puts Covered California on pace to exceed its projected base enrollment for the first six months of the program through March, Executive Director Peter V. Lee said. Some 626,210 enrollees are eligible for subsidies through January, Lee said, and roughly 8 in 10 have paid their first month's premium.

In a conference call with reporters, Lee stressed the goal is not meeting projections but making sure everyone is covered.

The exchange has made progress in enrolling young people and Latinos, he said. Enrollment of Spanish-speakers represented about 11.5 percent in January, compared with 5 percent during the first three months of enrollment. Exchange officials have outlined several initiatives to boost enrollment among Spanish-speakers and Latinos.

Sign-ups among 18-to-34 year olds also increased slightly to 26 percent. Federal officials have said they need 40 percent of enrollees to be under age 35.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1, 2013. The Sacramento Bee/Randall Benton.

February 14, 2014

A plan to provide undocumented immigrants in California access to subsidized health care has been spelled out in Senate Bill 1005 by Sen. Ricardo Lara, a Democrat from Bell Gardens.

Undocumented immigrants are excluded from the federal Affordable Care Act that is now offering legal residents the ability to purchase health insurance through government-run marketplaces.

Lara's bill would create two avenues for Californians who are in the country illegally to seek health care. The state would expand Medi-Cal to include undocumented immigrants whose incomes are under 138 percent of the poverty level -- about $32,000 a year for a family of four. And for undocumented immigrants who make more than that, the state would create a marketplace to sell insurance products.

The marketplace would be similar to Covered California -- the state's exchange that was created to sell insurance under the federal Affordable Care Act, also known as Obamacare.

The bill does not spell out a cost for California to extend health insurance to undocumented immigrants.

"We are doing the number crunching now," said Anthony Wright, executive director of the Health Access advocacy group that is supporting Lara's bill.

He said the goal is to provide health insurance for roughly 3 million Californians who don't have health insurance and cannot get it under the federal health program because of their immigration status.

"The idea under this bill is to extend the same level of help that the Affordable Care Act provides but to all Californians," Wright said. "It's about fairness and inclusion for all Californians."

February 11, 2014

Citing poor customer service and struggles to enroll Latinos, California lawmakers on Tuesday introduced legislation to expand and alter the makeup of the state health insurance exchange's five-member board of directors.

"Accountability starts at the top," said Sen. Norma Torres, D-Pomona. "After almost three years on the job, it is indisputable this board of directors needs additional expertise to provide oversight of staff in areas where improvement is needed."

Torres and members of the California Latino Legislative Caucus have been among the most vocal critics of Covered California's efforts to outreach to young people and Latinos.

Senate Bill 972 would expand the board to seven members and add four new types of experience to the list of expertise areas: Marketing of health insurance products, information technology system management, management information systems and consumer service delivery research and best practices.

Torres said board members must currently demonstrate command of only two of the following areas: Individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance, administering a public or private health care delivery system and purchasing health plan coverage.

January 28, 2014

Most health insurance plans offered on the state exchange will now feature quality ratings, giving consumers a better idea about their past performance.

Covered California, the state exchange, announced Tuesday that it recently incorporated the quality-rating system in its website, with marks ranging from four stars for the highest performers down to one star for the lowest.

Federal law requires the rating of plans, but officials here noted that the rating system's California debut comes about two years ahead of the mandate. Executive Director Peter V. Lee said his exchange is among the first in the nation to offer consumers a quality-rating system.

"We want to give consumers all the available tools to help them assess and choose plans in their regions," Lee said. "We are proud of the ratings in each of the exchange plans and recognize this is a preliminary look at exchange health plans."

Lee previously expressed concern that incorporating the ratings for some plans and not others would dissuade people from enrolling. His original recommendation called for implementing the ratings system for all plans offered on the exchange during open enrollment in 2015.

Health policy groups and highly-rated plans suggested the exchange simply add language to those plans explaining they had yet to receive any ratings. They sided with exchange board members who strongly recommended adding the ratings as soon as possible.

"We are pleased that those are in place and that folks can take advantage of it," said Anthony Wright, executive director of Health Access California. He also expressed gratitude that the exchange "didn't go down the path that everybody got four stars."

Ratings are a key tool for customers and an important signal to insurers, Wright said. As the exchange and insurers begin negotiations for next year's plans, insurers know that the exchange will look at consumer ratings as well as price, he said.

The ratings, based on consumer experiences, will be familiar to users of Amazon and Yelp where customers assign grades to products, movies and restaurant experiences. In this case, each insurance plan in the marketplace is compared with plans across the western region of the country.

Scores come from the Consumer Assessment of Healthcare Providers and Systems. Four-star plans placed in the top 25 percent of all of those rated. Three, two and one stars were awarded to plans ranking 50-to-75 percent, 25-to-50 percent and 0- to-25 percent, respectively.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1, 2013. The Sacramento Bee/Randall Benton.

January 27, 2014

The state's health insurance exchange is handing out six-figure contracts to a pair of consultants and a new marketing director that officials say will enhance the sustainability and help expand the program.

Covered California Executive Director Peter V. Lee said the consulting contracts would give the agency the "the exceptional staff and resources we need to make history."

Jeffrey Rideout will stay on as senior medical adviser on a one-year contract worth more than $411,000. A consultant in the areas of clinical quality, network management, delivery system reform and clinical and network analytics, Rideout previously served in senior executive and chief medical officer positions with Cisco Systems and Blue Shield of California.

"I think Jeff really has provided great leadership to us partnering with consumer advocates, with clinicians, with out health plans, really about how do we make sure that our consumers get the best quality care possible," Lee said last week.

Rideout is on the faculty at the University of California, Berkeley Haas School of Business. He also works as a consulting professor at Stanford University in the Department of Health Research and Policy. Terms of his previous contract were not immediately available.

Ana Matosantos, who until recently served as the state's finance director, will advise state exchange leadership and staff in "financial sustainability and budgeting issues, and evaluation analytics," according to a news release.

Matosantos, who will earn $20,000 a month on a six-month contract, served in the administrations of Govs. Jerry Brown and Arnold Schwarzenegger. She previously worked in the California Health and Human Services Agency and for the state Senate.

"There's few people as sharp as Ana in understanding not just numbers but how to put the numbers in context," Lee said.

To help oversee tens of millions in advertising and dollars, Garrison Rios was named director of communications and marketing. Rios was a director for Monterey Park-based Care1st Health Plan. At Covered California, he will lead the a newly created position in charge of planning, monitoring and controlling communications, public relations and marketing, Lee said.

Rios is tentatively scheduled to start Feb. 3, and will earn $165,000 a year.

PHOTO: Ana Matosantos, then the state finance director, converses with Natalie Cardenas of Anthem Blue Cross after Matosantos spoke to business leaders about Gov. Jerry Brown's budget proposal on Jan 13, 2011. The Sacramento Bee/Hector Amezcua

January 23, 2014

California's health insurance exchange failed to meet its first-class standards, frustrating tens of thousands of customers trying to enroll in coverage over the first three months of the program, officials said Thursday.

In a rare moment of public soul-searching, Covered California officials described the exchange's level of service as "completely unacceptable," and said they would apply the lessons to the next three months of enrollment commencing March 31.

"We know that thousands didn't have a good experience," Yolanda Richardson, deputy chief operations officer, told the exchange's board of directors on Thursday. "We're not satisfied with that. And we know we have a lot of work to do."

California continues to lead the nation with about 625,000 people enrolled in coverage. But long wait times and sluggish performance periodically plagued the exchange's customer service center and online enrollment portal.

"In many instances we did not meet our standard going back to our guiding principle of providing a first-class customer service experience," Richardson said, adding that the goal was to answer 80 percent of the calls in 30 seconds or fewer.

Wait times routinely exceeded one hour and in some cases were so long that customers were automatically disconnected, officials said.

The agency's inability to certify enough insurance agents and inaccurate or confusing notices mailed to consumers forced more of them to the phone lines and the internet. In some cases, they received no notices entirely, officials said.

The exchange is now working to add another 350 customer-service employees and a dedicated phone line for insurance agents. It also is ramping up its outreach to Latinos and other groups that experienced poor enrollment. Some 3,500 certified enrollment counselors are bilingual.

Executive Director Peter V. Lee said the exchange was boosting its marketing efforts in part thanks to a $155 million federal grant.

"Doing additional marketing is needed and is appropriate," Lee said, adding that in-person assistance will be a critical component in the coming months.

Earlier Thursday, Lee announced that former state Finance Director Ana Matosantos was hired as a senior adviser. Her compensation was not immediately known.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1, 2013. The Sacramento Bee/Randall Benton.

January 14, 2014

Beset by processing delays and customer confusion, two providers offering health coverage through California's new insurance exchange have pushed back their premium payment deadlines.

On Tuesday, a spokesman for Anthem Blue Cross of California said the company was pushing back its payment deadline to Jan. 31. Meanwhile, Kaiser Permanente set its new payment due date for Jan. 22.

Covered California had already extended its payment deadline for people with coverage beginning Jan. 1. The exchange's deadline is Wednesday, a change from the earlier deadline of Jan. 6.

A Covered California spokesman said the exchange's deadline would remain Wednesday.

"It's a deadline that was agreed unanimously to by the 11 health providers," spokesman Roy Kennedy said.

People who signed up for health coverage through the exchange have been complaining about long delays in receiving invoices needed to pay their first monthly premium. Others who made their payments are awaiting confirmation. Officials at Covered California and several insurance companies have acknowledged the raft of delays, including exceedingly long wait times for telephone customer service questions.

"We have extended the payment deadline for Jan. 1 coverage to Jan. 22 for those affected by processing delays, to allow all of our members time to receive and pay their invoices," Kaiser spokesman Chris Stenrud said.

"We have also started an outbound call campaign to reach members proactively to help them make payments on-line or by phone, and to know how to get needed care."

Stenrud noted that the "overwhelming majority" of those who enrolled in coverage that began this year have already received their invoices and paid for their coverage.

January 10, 2014

Immigrants who are in California illegally would qualify for health insurance under a bill Sen. Ricardo Lara plans to introduce.

Details of the plan have yet to be worked out. But Lara, a Democrat from Bell Gardens who chairs the Legislature's Latino Caucus, issued a statement today saying he intends to introduce a measure this year.

"We've made enormous strides to reduce California's uninsured population with the implementation of the Affordable Care Act, but we won't have a truly healthy state until everyone has access to quality, affordable coverage," Lara's statement says.

"Immigration status shouldn't bar individuals from health coverage, especially since their taxes contribute to the growth of our economy."

The federal Affordable Care Act, also known as Obamacare, excludes undocumented immigrants from being able to purchase health care through the new marketplaces states created for selling insurance. After the federal health care program is completely rolled out, experts predict that 3 million to 4 million people in California -- many of them undocumented immigrants -- will not have health care.

Some California counties offer health care to undocumented immigrants, but access varies around the state. Lara aims to make health insurance available statewide, but has not yet announced exactly how the goal would be achieved. Neither a bill number nor a cost estimate were available Friday.

Health advocacy groups have been pushing the message for the last year that undocumented immigrants should be able to participate in the federal health care plans. In last year's budget fight, they advocated unsuccessfully for funding for county-level insurance for the undocumented.

January 9, 2014

It's time for some fun with numbers -- state budget numbers -- as found in the summary of Gov. Jerry Brown's proposed 2014-15 budget:

-- Brown's proposed budget for 2014-15 is about 15 times as large as the first one he managed for the 1975-76 fiscal year.

-- The governor pegs the total 2014-15 budget of the general fund, special funds and bond funds at $154.9 billion, but the real number is well over $200 billion, when federal funds are included. That's the equivalent of more than 10 percent of California's entire economic output.

-- Most of the federal money underwrites health and welfare services and K-12 education. The "health and human services" budget, for instance, is $118 billion, but the state's general fund would contribute only $28.8 billion of that total, with most of the rest coming from the feds.

-- Spending on elementary and high schools would top $76 billion, with $45.3 billion from the general fund, another $16 billion from local property taxes and the final $15 billion mostly from the federal government. That translates into $12,833 for each of the state's six million K-12 students.

-- During the 2007-8 fiscal year, the state pumped $3.3 billion of general fund money into the University of California's $12 billion general purpose spending, but during 2014-15, the state's contribution would be $2.8 billion while revenue from tuition and student fees would have climbed from $6.6 billion in 2007-08 to $12.2 billion in 2014-15.

-- During that same period, the state's share of running the state university and college system would shrink less dramatically, from $3 billion to $2.5 billion while student fees would increase from $2.8 billion to $5.5 billion.

-- Although the state's prison population has dropped by about 30,000 inmates in recent years, thanks to pressure from federal judges about overcrowding, the state's spending on "corrections and rehabilitation" hasn't shrunk and, in fact, appears to have grown.

The 2014-15 budget pegs corrections at just under $12 billion, including sales taxes that the state gives counties to handle felons that have been diverted into local jails and supervision under "realignment." Spending on inmate health and dental care alone - another source of federal judicial pressure - has risen from an average of $7,580 per inmate in 2005-06 to a projected $18,415 in 2014-15.

-- During Brown's first stint as governor nearly four decades ago, the sales tax was the No. 1 generator of general fund revenues at 41 percent in 1975-76, with income taxes trailing at 34 percent. The 2014-15 budget projects income taxes to be almost 66 percent of the state's revenues and sales taxes just 23 percent.

--The proposed budget, if enacted, would spend the equivalent of 8.17 percent of Californians' personal incomes, by no means the highest level, but also not the lowest, since 1950, according to a chart in the budget.

The highest relative level of spending, 8.83 percent, occurred during the 1980-81 fiscal year, when Brown was serving his first stint as governor, and again in 2007-08 during Arnold Schwarzenegger's governorship. The lowest level, 4.62 percent, occurred in 1951-52, when Earl Warren was governor. Since 1975, the lowest has been 7.28 percent in 1983-84. the first budget for then-Gov. George Deukmejian.

Updated at 2:30 p.m. to include more historic data.
PHOTO: Gov. Jerry Brown presents his proposed budget at the state Capitol on Jan. 9, 2014. The Sacramento Bee/Alexei Koseff

January 8, 2014

And officials with Covered California, headquartered at 560 J Street in Sacramento, are on the hunt, a spokesman confirmed Wednesday.

That's because its offices at Downtown Plaza are sitting on some important real estate: the presumed future home of the Sacramento Kings.

City and team officials have been working to clear the way for an arena. Last night, the Sacramento City Council moved to file eminent domain proceedings against a group that owns the former Macy's furniture and men's store in the mall.

Roy Kennedy, a spokesman for Covered California, said the exchange's facilities management team is in the process of securing a long-term location.

"The hope is Covered California will have a permanent home soon somewhere in the greater Sacramento area," Kennedy said.

The exchange, which began taking enrollments in October, also operates a trio of service centers in Rancho Cordova and in Contra Costa and Fresno counties.

PHOTO: Sacramento Mayor Kevin Johnson talks with Alice Huffman, president and chief executive of California NAACP before a Covered California press conference at Sacramento City Hall in October. The Sacramento Bee/Hector Amezcua

January 7, 2014

California is doing a poor job of meeting the health, education and economic needs of its children, Children Now, an Oakland-based advocacy organization, says in its latest Children's Report Card.

The unmet needs for well-being are especially acute among the nearly half of California's children who live in low-income households, the organization's president, former Assemblyman Ted Lempert, said.

"The declining status of kids in California is the biggest threat to the health and economy of our state," Lempert said in a statement accompanying the report. "Californians across the board want to see children doing better and we need to hold the state's policymakers more accountable this year for making that happen."

The annual report covers 27 issues, giving the state a grade in each, noting where there has been progress and making recommendations for action. It praises, for example, the newly enacted overhaul of state school finance that directs more money to school districts with large numbers of poor and English-learner students, but says that overall financing of the state's schools remains about $3,500 per pupil below the national average.

All of the Children Now recommendations would cost substantial amounts of money. Just raising school spending to the national per-pupil average, for instance, would take another $21 billion a year. But the organization's report contends that spending the money would pay economic dividends for the state in the future.

PHOTO: Children participate in the 10 years-old and under race during the Superheroes 5K run on June 16, 2013 in Sacramento. The Sacramento Bee/Paul Kitagaki Jr.

December 4, 2013

Californians fracture along partisan lines when asked about federal health care reform, a new Public Policy Institute of California poll finds.

While 60 percent of California Democrats reported a favorable view of the law, only 13 percent of Republicans hold that view, against a resounding 80 percent who rejected it. Independents were more mixed, with 40 percent approving, 51 percent disapproving and nine percent saying they didn't know.

The sum of those results: Californians are evenly divided on the sweeping new reordering of American health care, with an identical 44 percent supporting and backing it, according to the poll.

Those who don't have health insurance, the main demographic targeted by the law, also appeared more likely to be supportive: 50 percent of Californians lacking insurance support the law against 43 percent saying they viewed it unfavorably. Those with insurance registered an even 43-43 split.

In sharp contrast to Republican-led states that have resisted the new law, refusing to expand Medicaid or declining to set up their own health insurance exchanges, deeply Democratic California has enthusiastically forged ahead in laying the groundwork.

That has meant, among other things, that California's health insurance enrollment rates have outstripped the woeful signup numbers on the federal exchange and some state exchanges. Residents of the state are largely aware of the state exchange, named Covered California: 68 percent affirmed that a California marketplace exists, against 14 percent who said there is not a state exchange and 18 percent who said they didn't know.

PHOTO: A Sacramento State student looks at a pamphlet with information on Covered California on Thusrday, October 16, 2013. The Sacramento Bee/Hector Amezcua.

December 4, 2013

Adding his voice to a rising chorus of criticism, a Democratic assemblyman called on Wednesday for a legislative investigation of a health care website created by California Republicans.

Assemblyman Jimmy Gomez, D-Los Angeles, became the latest California Democrat to assail a website he says Assembly Republicans created to amplify critiques of the law, rather than help Californians enroll in insurance via Covered California, the state's newly operational exchange. Gomez has sent the Assembly Rules Committee a letter asking them to investigate.

In a statement released earlier Wednesday, California Democratic Party Chair John Burton said the website demonstrated "Republicans in California have no qualms about following their national Party's lead when it comes to spreading misinformation about the Affordable Care Act."

A click on the site's "I don't have insurance" tab - much larger than a small box linking to the Covered California site that was not initially on the main page - leads to information about IRS penalties for consumers who don't obtain coverage. The main page displays links to articles about people losing their health insurance or their doctors.

November 7, 2013

California continues to extend a patchwork of safety-net programs for its poor and uninsured residents despite making progress in several of the state's 58 counties, according to a report released Thursday.

The report from the Health Access Foundation documents large disparities for the estimated 3 million to 4 million residents projected to remain uninsured even after the federal health care law is fully implemented.

The goal of the report is to provide a baseline for county officials as they weigh key decisions in the coming months about the level of services they extend to the indigent and uninsured.

Anthony Wright, executive director of Health Access California, said the pending county-by-county debate must center on "how we provide the services to our friends, our neighbors, or fellow Californians."

October 22, 2013

Kaiser Permanente and two other health plans criticized administrators of California's public health exchange Monday for postponing posting quality ratings for health plans on the exchange's website, saying the delay is a disservice to customers.

"We strongly urge that the display of health plan quality ratings go forward as originally planned, in the interest of both transparency to consumers and fair competition among Covered California's plan partners," the health plans said in a letter to members of the board of Covered California.

In the letter, Kaiser, Sharp Health Plan and Western Health Advantage said "it is unimaginable that consumers would prefer to be kept in the dark when quality information is readily available for their consideration."

Covered California announced this summer that it would delay posting quality ratings for health plans online, saying information used to rate the health plans was out of date.

The letter from Kaiser, Sharp and Western Health comes ahead of a Thursday meeting at which Covered California officials are expected to discuss the issue.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1. The Sacramento Bee/Randall Benton.

October 15, 2013

Two weeks after opening its doors, the state insurance marketplace announced today that nearly 1.6 million individual visitors had come to its online portal and more than 104,000 customers called into its service center through Saturday.

Covered California began enrolling customers on Oct. 1 for insurance plans that start Jan. 1. Average wait times at call centers improved significantly - to less than two minutes from 15 minutes - and roughly 94,500 applications were started at CoveredCA.com through Saturday.

Last week, Executive Director Peter V. Lee said he wasn't inclined to release data so early but began doing so to counter persistent criticism of the agency's initial performance.

The state health insurance exchange also has made progress on certifying those tasked with enrolling new customers - although in some cases not as quickly as officials wanted. The agency reported certified 279 enrollment counselors, 1,295 insurance agents and 5,287 county eligibility workers in the first 12 days.

Some 3,824 enrollment counselors, 3,382 insurance agents and 5,421 county workers were in the process. In all, 17,768 insurance agents have registered to sell plans on the state exchange. Licensed insurance agents must receive training through Covered California.

On Monday, Lee told The Bee that fewer than half of the registered agents have been through the training because of technological snags.

"We've had sticky wickets on our IT system for training," Lee said, adding that the problem was being addressed to remove the logjam.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1. The Sacramento Bee/Randall Benton.

October 14, 2013

The chief of California's health insurance marketplace said he has no concerns about advertising campaigns designed to derail the federal health care law, arguing there is no "echo chamber" for such efforts in the Golden State.

Covered California Executive Director Peter V. Lee has been crisscrossing the state for roughly two dozen town hall meetings and said he has been heckled just once - by an individual speaking out against U.S. intervention in Syria.

In an interview with The Sacramento Bee's Editorial Board Monday, Lee said the policies behind the health care overhaul were embraced by officials from both major political parties. Political roots of the law involve former Republican governors Mitt Romney in Massachusetts and Arnold Schwarzenegger in California, he said.

"The fight over it today I really think is not really about the underlining policies. It's the fight over not liking the president, Obama, and wanting to play for Congress," Lee said, adding that the law adheres to market solutions and provides consumer choice.

Lee was responding to a question about whether he fears conservative marketing campaigns urging potential consumers, particularly young, health people to "opt-out of the health care law would have any sway with Californians. Among the efforts is the now-viral online advertisement from a group with financial ties to billionaire industrialists Charles and David Koch.

"I don't think the Koch brothers are going to spend a dime on having ads run in California," Lee said.

October 14, 2013

Officials with the state's health insurance marketplace acknowledged prematurely releasing an online directory of doctors and hospitals on Tuesday, a week after opening enrollment for its version of the federal health care overhaul.

Covered California removed the directory within a day of release after discovering it was plagued by inaccuracies and sluggish performance. The search tool was designed to allow customers to determine whether their providers were included in health plans offered by the exchange.

In an interview with The Sacramento Bee Editorial Board Monday, Covered California Executive Director Peter V. Lee said the directory never should have been launched.

"Staff needs to do a better job of reining me in," Lee said. "I want to have great customer service and I push us to get stuff out there. But I and we need to be careful about not pushing too fast. That was an example of actually being out there too fast."

Lee said early criticism of the online federal marketplace and to a lesser degree the state exchange often fails to consider the rollout efforts involve implementing a massive system without what many in the private-sector would consider appropriate time for testing.

He described the directory as "best practice" in the corporate world and lamented that its late arrival and temporary removal were making news despite the state marketplace's comparatively smooth launch.

"Shame on us for stating that's how high of a bar we want to set up for ourselves for customer service," he said. "But if that's as bad as it gets, I am feeling pretty good."

The exchange anticipates reintroducing the directory within a week.

PHOTO: The executive director of Covered California, Peter V. Lee, speaks to members of the media during the launch of Covered California in Rancho Cordova on Oct. 1, 2013. The Sacramento Bee/Randall Benton.

October 2, 2013

Saying if it's good enough for the people it should be sufficient for the California Legislature, Assemblyman Brian Nestande plans to introduce legislation that shifts all lawmakers to the state's version of the new federal health care law.

Nestande, R-Palm Desert, says lawmakers who want to continue to receive state benefits should be forced to enroll in Covered California, which began processing applications Tuesday in advance of the Affordable Care Act taking effect Jan. 1.

"The idea is we should go into the exchange, we should be dealing with the exchange, because this is a big change," Nestande said. "I think there is going to be a number of unintended consequences that come up in this process that are going to have be dealt with.

"We should be experiencing those difficulties just like individuals that are, by law, mandated to go purchase health care."

Nestande, who is seeking the congressional seat held by freshman Democratic Rep. Raul Ruiz of Palm Desert, said he opposes the federal health care law.

October 1, 2013

Technical issues have hobbled the launch of California's online health insurance portal, created as part of the federal health care overhaul.

While a dispute over the new law sent the federal government careening into a shutdown, states have stuck to an Oct. 1 open enrollment date for the new health insurance exchanges that constitute one of the law's central features. California marked the occasion with fanfare, holding official events around the state.

But a Tuesday morning visit to the online marketplace where consumers can shop for insurance plans and compare price and benefits, suggested that the roll out has slowed.

A click on the "start here" button leads to a page that takes several minutes to load. When the page does load, its formatting appears to be faulty, and clicking through to the next step brings additional delays. When The Bee called the customer support line, a recording advised that the wait for service would be longer than 30 minutes.

A non-scientific search of the hashtag "#CoveredCA" on Twitter revealed users encountering similar problems, with a steady stream of messages testifying to long lags.

"We're thinking there may be some individual browser problems but obviously the high traffic can slow it down," said Anne Gonzales, a spokeswoman for Covered California, pointing to a "very high volume" of people logging on. "We're making fixes as we go along, so it should be better later in the day, but it's up and running."

PHOTO: Executive Director of Covered California Peter V. Lee speaks to members of the press during the launch of Covered California in Rancho Cordova on Tuesday, October 1, 2013. The Sacramento Bee/Randall Benton.

September 20, 2013

A Sacramento County Democratic Party official has resigned over an offensive tweet that involved a fellow Twitter user's children.

Tempers flared Friday as House Republicans voted to defund President Barack Obama's signature health care law, which led to some questionable Twitter decisions.

Amanda Carpenter, a speechwriter for Sen. Ted Cruz, R-Texas, tweeted to urge Republicans on. Then Allan Brauer, communications chair for the Democratic Party of Sacramento County, lashed out with a response involving Carpenter's kids.

That didn't sit too well with Twitter users, who raised a chorus of condemnations. The exchange made it to the website of the National Review and to the Drudge Report, both prominent conservative outlets.

"Publicly wishing death on a mother's children for her political views is an utterly unacceptable tone in partisan discourse," Sue Blake, chair of the Sacramento County Republican Party, wrote in an email to The Bee. "I ask that my counterparts in the Sacramento Democrat Party repudiate this type of rhetoric and immediately separate themselves from these kinds of partisan attacks on women.

But it did not end there. In an email, Democratic Party of Sacramento County chair Kerri Asbury said the party had sought and accepted Bauer's resignation.

"The comments by our volunteer communications chair are appalling and inexcusable," Asbury wrote. "No matter what our political disagreements may be, wishing harm is never an acceptable response during heated public debate or any other time."

Here is the original exchange:

@amandacarpenter May your children all die from debilitating, painful and incurable diseases.

August 30, 2013

With the new federal medical insurance program on the verge of implementation, California has the largest number of medically uninsured residents of any state, but its percentage of uninsured is only 10th highest, according to a new Census Bureau report.

Just over 20 percent of Californians under the age of 65 were uninsured in 2011, the last year for which data are available. Texas had the highest rate, more than 25 percent, while Massachusetts had the lowest, less than 5 percent.

The report covers counties as well as states and reveals that in California, wealthy Marin County has the lowest rate of uninsured at 12 percent -- about the same as Iowa's rate, the nation's eighth lowest.

California has more than six million residents without medical insurance and is among the states that have most vigorously embraced the Affordable Care Act. It is implementing the optional extension of Medicaid (Medi-Cal in California) to more low-income residents and has set up an exchange, Covered California, to facilitate acquisition of insurance by individuals and employers. State officials believe that the state's medically insured total will be reduced at least by half with those steps.

PHOTO: Nurse Practitioner David Weller, left examines patient Jose Andino at The Effort medical clinic in North Highlands on Friday, July 13, 2012. The Sacramento Bee/Randall Benton

August 16, 2013

A quarter of Californians are overweight, but the state has the nation's 11th lowest rate of obesity, according to a new report from the Washington-based Trust for America's Health and the Robert Wood Johnson Foundation.

Generally, the report found that obesity rates are highest in Southern and Midwestern states, with Louisiana having the highest at 34.7 percent, and markedly lower in Northeastern and Western states, with Colorado having the lowest at 20.5 percent.

The years of data collection on obesity discovered a trend toward equalization of the genders. A decade ago, American women had obesity rates six points higher than men - 33.4 percent to 27.5 percent - but the latest data indicate that rates are very similar, albeit much higher for both genders. They are 35.8 percent for men and 35.5 percent for women.

Both numbers are lower in California, but men are higher in this state as well - 26.2 percent for men and 23.8 percent for women. The study also found that California's baby boomers, overall, have an obesity rate of 31 percent, while for older Californians it's 21.1 percent. For young adults aged 18 to 25 years old, it's 13.7 percent.

August 12, 2013

State Sen. Ed Hernandez is giving up for this year his effort to expand the kinds of medical services optometrists can offer in California.

The Democrat from West Covina said Monday that he is pulling his Senate Bill 492 from any further action in the Legislature this year, and will instead push for its passage in 2014. The bill would allow optometrists to diagnose and treat all kinds of ailments related to the eye, including conditions such as diabetes.

"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition," Hernandez told The Bee.

"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it."

The bill is one of three Hernandez carried this year that would expand the so-called "scope of practice" for various medical professionals. He argued the bills were necessary to allow more people access to health care as federal law soon begins requiring everyone have health insurance. But the bill package set off a war with the California Medical Association, a powerful force in the Capitol that lobbies on behalf of doctors and worked hard to kill Hernandez's bills.

His SB 491, which would allow nurse practitioners more authority, was rejected by the Assembly business and professions committee last week and is up for reconsideration tomorrow. His SB 493, that expands the duties pharmacists may perform, is making its way through the Assembly. The optometry bill was scheduled for a committee vote tomorrow before Hernandez pulled it.

Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.

"We're glad there is extra time to work out what some of those difference are," she said. "Our biggest concern has been and remains that patients are being treated by qualified health care professionals."

Hernandez said it's too soon to say what kind of compromise is in order:

"We're not willing to give up on anything because we haven't had that conversation yet with the opposition."

August 8, 2013

Board members of the California Health Benefit Exchange voted Thursday to delay soliciting bids for medical plans that include pediatric dental care until next year.

Covered California, the state's health insurance exchange, has said it will offer five stand-alone pediatric dental plans for 2014 as well as what's called a "bundled" plan in which insurers pair a stand-alone dental plan with a medical plan.

Critics have argued that Covered California should also offer so-called "embedded" pediatric dental plans that are included in medical plans.

But Leesa Tori, senior adviser for plan management, told the board at its special meeting that too many questions remain for the exchange to offer embedded pediatric dental plans before 2015.

August 7, 2013

Californians shopping for health insurance through the state's new marketplace will have a dozen options to choose from, officials announced Wednesday.

Covered California, the insurance exchange created under the new federal health care law, announced a list of insurance firms that have signed contracts to sell health plans on the exchange. The list includes major players like Anthem Blue Cross and Kaiser Permanente as well as smaller companies like Molina Healthcare and Chinese Community Health Plan.

Six of those firms will also offer insurance through the Small Business Health Options Program, a program aimed at helping small businesses offer insurance to employees.

Unlike Republican-led states that have resisted implementing the health care law, California has moved to erect a marketplace and passed legislation that will enroll in more than a million new Medi-Cal customers.

It solicited competitive bids and negotiated with insurers on the plans to be offered through Covered California, where consumers will be able to comparison shop for health plans - for lower-income Californians, with the help of a government subsidy. Wednesday's announcement marked the next step toward Covered California enrollment, which begins Oct. 1.

"This is what was necessary to put everything in place, and now the computer programmers can put these options into the portal that will be available in about 50 days," said Anthony Wright, executive director of the organization Health Access California.

The small business program will offer plans from Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan and Western Health Advantage.

PHOTO: Executive Director of Covered California, Peter V. Lee addresses the media as California's health exchange held a news conference to announce how much it will cost to buy premiums under the new federal health care program in the state, at the California Museum, Thursday, May 23, 2013. The Sacramento Bee/Lezlie Sterling.

July 31, 2013

Middle-age, low-income workers living in California's rural counties were the most likely to lose their jobs and their health insurance during the severe recession that struck the state six years ago.

That's the conclusion of a new report from researchers at UCLA's Center for Health Policy.

As unemployment more than doubled between 2007 and 2009, the study found, the number of Californians without health insurance rose more than 10 percent to 7.1 million. And while the poorest Californians were able to secure health coverage through the state's Medi-Cal and now-defunct Healthy Families programs, others were left to scramble for coverage.

"Whether because mid-career workers are viewed as too expensive or because there is a deeper bias against older workers, the data suggests the ax is first to fall on the baby boom generation," Shana Alex Lavarreda, the study's lead author, said in a statement accompanying its release. "This might open the door for policymakers to question the fairness of hiring and firing in the next economic cycle."

The study notes that similar impacts of future recessions on health care coverage are likely to be less severe because of the advent of the federal Affordable Care Act. The health care overhaul aims at reducing the state's 7-plus million medically uninsured residents by several million, either through expansion of Medi-Cal eligibility or from private, federally subsidized insurance under the new California Connected health care exchange.

PHOTO: A patient is examined in Carmichael on March 3, 2009. The Sacramento Bee/Randall Benton

July 23, 2013

Finding dental care for children on Medi-Cal is not always as easy as it seems, according to a study released by The Children's Partnership on Monday.

Parents of children on Medi-Cal can search the U.S. Department of Health and Human Services website InsureKidsNow.gov to find dentists in their area. Researchers with The Children's Partnership surveyed 145 of the 220 dental providers listed on the website as accepting children on Medi-Cal.

The survey found that nearly 10 percent of dentists who were listed as accepting new patients on Medi-Cal actually would not accept new patients.

Researchers called to schedule appointments for two children, a 10-year-old and a three-year-old. Approximately 19 percent of providers refused to treat at least one of the children because of their age.

Unlike comprehensive health insurance, Californians are not required under federal law to purchase pediatric dental care, which is available to serve children and teenagers up to age 19.

But Covered California Director Peter V. Lee said that providing affordable dental policies is a key part of the exchange's mission to boost health statewide, particularly for young and vulnerable residents.

"Dental care is a vital component of overall health, and especially critical for our state's children," he said. "Access to dental services as a youngster means better health, both for children and as they get older."

June 12, 2013

Democratic members of the California Senate Health Committee had what one of them called "a little awkward conversation" Wednesday with Democratic Assemblywoman Mariko Yamada over her bill to reinstate day care centers for adults with physical or mental disabilities, pleading with her to accept amendments.

Yamada refused to remove bill language to prohibit the state from allowing more for-profit firms to provide the care, characterizing her refusal as a philosophical objection to "making a profit off the public dollar."

And with that refusal, Yamada's measure, Assembly Bill 518, died without a motion or a vote. It was an unusual end for the measure, which had whizzed through the Assembly with nary a negative vote and bipartisan support.

Two years ago, the Legislature and Gov. Jerry Brown eliminated the day care program under the state's Medi-Cal program as one of the reductions made in "safety net" services to balance the state budget, turning aside complaints that its elimination would force beneficiaries into more expensive institutional care.

June 6, 2013

California voters last year passed Proposition 39, which changed the way multistate corporations are taxed, creating a big pot of money - about a billion dollars a year - with half required to be spent on energy-saving projects in schools, colleges and other public buildings.

Seven months later, the Capitol's politicians are still wrangling over how to divvy up the more than $400 million going to schools. It's one of the stickiest of several high-dollar issues still in limbo with scarcely a week remaining before the June 15 constitutional deadline to pass a budget.

Just before the Legislature's budget conference committee recessed indefinitely late Wednesday, Sen. Kevin de León, D-Los Angeles, a co-sponsor of Proposition 39, engaged in a pointed exchange with Gov. Jerry Brown's budget point man, Michael Cohen, over Brown's plan to distribute the school money widely, based on attendance, with every school in the state getting at least a token amount.

That runs counter to plans by de León and other Democratic legislators to concentrate the money on fewer schools with, they say, the largest potential to achieve greater energy savings and create jobs in low-income areas.

June 4, 2013

Thousands of doctors, nurses, unionized health care workers and Medi-Cal patients flocked to the Capitol on Tuesday to protest possible cuts to the Medi-Cal program.

Gov. Jerry Brown's proposed budget calls for a 10 percent reduction in payment to Medi-Cal providers, a move that opponents say would reduce the poorest patients' access to healthcare. He has shown no signs of backing down from the proposed cut.

The "We Care for California" Coalition, which includes health care providers, insurance firms and associations representing doctors and hospitals, organized more than 100 buses to bring protesters from across California to the rally.

Dave Regan, president of Service Employees International Union-United Healthcare Workers West, called upon SEIU-UHW members at the rally to make their voices heard to legislators.

"We deserve better than politics as usual. Better than the politics of disenfranchisement, the politics of erosion of care, the politics of saying 'it's somebody else's problem,'" Regan told the crowd. "And if we can't persuade the governor, we need to find two-thirds of this legislative body who know what the right thing is."

May 28, 2013

A "conference committee" is a parliamentary device to reconcile differing versions of legislation passed by both houses of the Legislature, but in California's Capitol is rarely used except to produce a final legislative version of the state budget.

The 2013 budget conference committee is scheduled to convene on Friday - 15 days before the constitutional deadline for budget passage - but there are few major differences between the Senate's version of the 2013-14 budget and the Assembly's version.

That doesn't mean that there aren't some serious differences over the budget. However, the conflicts are not within the Legislature, but between its Democratic majorities in both houses and Gov. Jerry Brown. And they will be aired when Brown's representatatives appear before the committee.

Brown wants to take a conservative approach on estimating revenues while the Legislature's budgets embrace a projection by its budget analyst, Mac Taylor, that the state could have $3.2 billion more to spend than Brown assumes.

The legislative budgets would give most of the extra money, if it materializes, to schools, as the state education financing law dictates, and spend much of the remainder to bolster health and welfare programs.

Brown has warned the Legislature publicly that he'll resist any expansion of spending beyond his parameters.

Another point of budget conflict has to do with how the school money, whatever its size, will be distributed. Brown wants to shift more money into districts with large numbers of poor and/or English-learner students but the Legislature has balked at Brown's plan and wants to scale back the extra spending on those students in favor or broader grants of aid to all districts.

PHOTO CREDIT: Gov. Jerry Brown stands for applause with Assembly Speaker John A. Perez, D-Los Angeles and Senate President Pro Tem Darrell Steinberg, D-Sacramento before delivering his State of the State speech in January. The Sacramento Bee/Hector Amezcua

May 23, 2013

Californians received the bottom line Thursday on which insurance firms will sell policies on the state's new health-care exchange this fall and how much those premiums will cost.

The announcement by Covered California, the marketplace for such policies, brings into sharper focus the impact of the nation's health-care overhaul on families and their pocketbooks.

Thirteen health plans were picked to sell plans, with none of the state's 19 designated regions having fewer than three plans to serve consumers, Covered California announced.

Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente were among the firms chosen. Their tentative selection is subject to rate review by state regulators.

California's 19 geographic regions will average five health plans from which to choose. Even in most rural areas, consumers will have two or three options - though in a small number of counties only one plan will be available, officials said.

The broad-based coalition includes groups representing physicians, health plans, hospitals, dentists, first responders, and the state's largest labor union of health-care workers - Service Employees International Union.

Dr. Paul R. Phinney, president of the California Medical Association, described the gathering as an "unprecented coalition of providers of health care in our state to make sure that the Affordable Care Act is implemented in a smart and sensible way."

"Quality health care is going to be less available and less affordable in California if we continue to cut our system to the bone," Phinney said.

April 23, 2013

As the federal Affordable Care Act begins to take effect, ever-fewer California employers are offering medical insurance to their workers, according to an annual survey by the California Healthcare Foundation.

From 2002 to 2012, the proportion of employers offering such coverage declined from 71 percent to 60 percent. Meanwhile, the costs of health care insurance have risen by just under 170 percent since 2002, more than five times the overall inflation rate.

The average premium for single-person coverage was $545 per month in 2012, substantially more than the national average of $468, while family coverage cost an average of $1,386 in California and $1,312 nationally, the foundation said.

The survey also found that larger employers with high proportions of full-time workers were most likely to offer health insurance to workers and that deductibles tended to be much higher among small employers than among large ones.

Finally, 21 percent of employers reported that they had increased the share of insurance costs borne by employees during the preceding year, while 17 percent either reduced workers' costs or absorbed increases.

April 10, 2013

California may have high housing, fuel and electric power prices, but Californians' spending on health care is below the national average, according to a new data compilation by the Wall Street Journal.

California was spending $6,258 per resident on health care - doctors, hospitals, prescription drugs - in 2009, the latest year for which complete data were available, the Wall Street Journal study found.

That was about $600 less than the national average, with spending ranging from a high of $10,349 in Washington, D.C., to a low of $5,031 in Utah.

Overall, the data indicated that California was spending about $225 billion on health care from private and public funds in 2009, more than 10 percent of the state's economy and the largest single sector of its economy.

The number has grown since and is likely to jump sharply once billions of additional dollars begin flowing into the state's health sector from the federal Affordable Care Act. It will provide coverage to at least half of the state's estimated 7 million medically uninsured residents, much of it coming from the federal government but some from individuals and private employers.

The Wall Street Journal said that California's per capita spending on hospitals, the biggest single chunk of health care expense, was particularly low in 2009 - $2,077 or sixth lowest among the states. Its spending on prescription drugs was also among the nation's lowest, as was its level of obesity, at 23.8 percent of the adult population.

March 28, 2013

Middle class Californians counting on federal health-care reform to lower their insurance premiums are in for a double-digit shock next year, a new state study shows.

People or families who buy insurance for themselves could see rate increases of up to 30 percent. Milliman consulting group performed the analysis, but scope was limited to the individual market, meaning about 5 million Californians who do not receive insurance through their employer.

Millions of low-income Californians will see their costs plummet while costs rise for households where incomes exceed about $46,000 for an individual or $94,000 for a family of four, the study concluded.

Comparisons are skewed somewhat by stiffer coverage requirements for next year's plans, but the bottom line is that the poor are likely to pay significantly less than they do now while middle-class families dig deeper into pocketbooks.

"Our top priority is to provide Californians with affordable health insurance options, and we are pleased that most individuals will pay lower rates and receive better coverage," said Peter V. Lee, director of the state's health-care exchange, which commissioned the study.

March 26, 2013

Health care has become, by most measures, the largest single piece of the California economy, well over 10 percent of its $2 trillion output of goods and services -- and destined to grow as the state extends medical insurance coverage to millions of Californians under the federal Affordable Care Act.

Nevertheless, a new nationwide study finds that as large as it may be, the health care spending in California has been relatively small, compared to other states.

The statistical compilation by the Dallas-based National Center for Policy Analysis found that as of 2009, the latest year for which complete data were available, California was sixth lowest among the states in public and private health care spending as a proportion of its economy. The state's relative spending, 12.5 percent of its economy, was just 84 percent of the national average.

March 21, 2013

Love it or hate it, here it comes. Health-care advocates held a series of events throughout California on Thursday to celebrate the third anniversary of Congress' passage of the Affordable Care Act and to urge state officials to move quickly in preparing for its implementation in January.

"We think this is important to California's future, as transformative, as the building of the railroad or the establishment of the University of California," Anthony Wright, director of Health Access, said of Obamacare. "We need to embrace it fully and urgently."

Federal health-care reform cleared its final congressional hurdle and was sent to President Barack Obama on March 23, 2010. Hotly contested, the massive reform measure was designed to overhaul health insurance in a way that ensures that nearly all Americans purchase at least a basic level of medical coverage or pay a penalty.

Health Access, a nonprofit group supporting Obamacare, released a report Thursday that concluded millions of Californians already have benefited from consumer protections, subsidized care, business tax credits, or changes in insurance coverage sparked by the Affordable Care Act.

March 13, 2013

Citing a need for more medical professionals to be able to treat patients who will soon have health insurance under the federal Affordable Care Act, Sen. Ed Hernandez today introduced a package of bills allowing optometrists, pharmacists and nurse practitioners to expand the services they can offer patients.

The so-called "scope of practice" bills set the stage for a massive fight with the state's doctors, who will likely fight to protect their role as gatekeepers to medical care.

In a news conference at a Sacramento health clinic, Hernandez argued that because of a shortage of doctors in California, other kinds of medical professionals should be permitted to offer patients more care.

"Here in the state of California, we have a capacity issue. We have a work-force shortage," Hernandez said, adding that the problem is most severe in rural and inner-city areas.

With the federal health care overhaul kicking in, he said, nearly 5 million Californians who don't now have health insurance will be required to be insured as of next year.

"How is it that we're going to be requiring somebody to purchase health insurance, but yet they won't have access to a doctor?" Hernandez said. "This is what we need to address."

Hernandez's proposals will soon be spelled out in Senate Bills 491, 492 and 493. Sen. Fran Pavley is also working on Senate Bill 352, which would expand the scope of practice for physician's assistants.

March 11, 2013

Dozens of bereaved parents who lost children to opiate overdoses told state legislators Monday that the California Medical Board is failing to protect the public from "dirty doctors" who over-prescribe addictive drugs, especially to young adults.

The reports of a growing epidemic in California mirror nationwide statistics from the Centers for Disease Control and Prevention, which revealed new data recently showing the number of deaths due to pain medicine overdoses have increased for the 11th year in a row.

Testimony from California parents, each displaying a framed photograph of their lost loved one, came during a routine review of the California Medical Board in a Joint Oversight Hearing of the state Legislature. Every 10 years, the Legislature's business and professions committees in the Senate and Assembly must review the performance of the board and approve its continued existence.

March 7, 2013

The Legislature approved two bills today to expand Medi-Cal coverage to more than 1 million low-income California residents under the federal Affordable Care Act.

Assembly Bill 1x 1 now heads to the Senate, after passing the Assembly 53-22. Shortly after the Assembly vote, the Senate sent the Assembly a similar Medi-Cal expansion bill 24-7. Senate Bill 1x 1 is authored by Sen. Ed Hernandez, D-West Covina.

"Expanding health coverage to low-income adults will ensure Californians have access to care, which will help ensure a more healthy workforce and implementing the expansion will bring billions of federal dollars to the California economy," Hernandez said.

Assembly Speaker John A. Pérez, D-Los Angeles, authored AB 1x 1 and said it is an important step to ensuring people living significantly below the poverty line have access to quality care. In addition to expanding eligibility, Pérez's bill aims to streamline enrollment to reduce the time it takes to receive coverage.

Under the health care law pushed by President Barack Obama, most Americans will be required to buy health insurance by January 2014 or pay a penalty. The tab for the California Medi-Cal expansion will be picked up by the federal government for the first three years. In subsequent years, the federal government will cover 90 percent of the cost.

March 6, 2013

The perennially contentious relationship between the state and county governments over money has a new flash point -- the expansion of Medi-Cal coverage to more than a million low-income Californians under the new Affordable Care Act.

The conflict -- aired Wednesday in an Assembly budget subcommittee hearing -- has two prongs:

 Whether the state or counties will manage the expansion.
 Whether the state should "claw back" some of the money it now pays to counties to pay for indigent medical care -- on the theory that many of the half-million poor beneficiaries will become Medi-Cal patients next year, raising state costs.

Gov. Jerry Brown's administration is still undecided whether to opt for county or state management, but the larger counties have said they don't want it, the Legislature's own budget analyst recommends state management, and the major pending implementation bill also opts for state operation.

February 13, 2013

Millions of uninsured Californians will soon be required to purchase health insurance, and Wednesday morning they got a glimpse of what to expect under the state's marketplace.

Covered California, the organization responsible for implementing the federal health insurance overhaul, released a blueprint for what types of coverage will be available on the state's insurance exchange. The federal Affordable Care Act requires state exchanges to be up and running by 2014.

Peter Lee, executive director of Covered California, said the government-regulated exchange will add some much-needed standards and transparency to California's health insurance market.

"They are ready to play by the rules," Lee said of the insurance industry at a news conference at his organization's downtown Sacramento headquarters. "They are ready to embrace the opportunity to compete not based on a shell game of hidden benefits but based on quality and value."

There will be four plans available: platinum, gold, silver and bronze. The premium would cover 90 percent of the cost under the platinum plan, with copays making up the other 10 percent. Under the bronze plan, the premium would cover 60 percent, and copays would account for the other 40 percent.

January 16, 2013

California has one of the nation's lowest rates of smoking -- just 13.6 percent of adults light up -- but the American Lung Association gives the state low marks for reducing tobacco use, primarily for not taxing cigarettes more and not spending more on anti-smoking programs.

The critique of California is contained in the organization's annual state-by-state "report card" on anti-smoking efforts.

While praising the state as an early leader in persuading its residents to give up cigarettes, the association raps the state for not raising cigarette taxes higher than the current 87 cents a pack and decried voter rejection of a $1 per pack increase last year (Proposition 29). It said California is one of only three states that haven't raised smoking levies since 1999. It also singles out the Legislature for stalling action last year on Senate Bill 575, which would have removed exemptions from smoke-free places.

January 3, 2013

The Obama administration gave California's subsidized health care marketplace conditional approval today as the state prepares to sign up subscribers in October.

The marketplace, dubbed Covered California, plans to serve hundreds of thousands of uninsured residents who are eligible in 2014 for federal subsidies to obtain health coverage. Starting next year, all Americans are required to obtain insurance or pay a penalty under the 2010 federal health care overhaul.

California has received $237 million in federal grants so far to build its marketplace, which pays for a new IT system that enrolls subscribers statewide, marketing efforts and staff to operate the program. Federal officials are watching California with particular interest, given that it is the most populous state and has unique language and cultural barriers among its uninsured population.

To date, the federal government has approved so-called "health exchanges" in 19 states and Washington, D.C.

December 21, 2012

California primary care doctors expect to receive more than twice their current reimbursement rate for treating Medi-Cal patients next year, but those higher payments will now be delayed, according to state officials.

The change in reimbursement rates is part of President Barack Obama's health care overhaul. The federal government has agreed to fund primary care for Medi-Cal patients at the same rate that it pays Medicare providers, hoping to expand the number of doctors willing to treat low-income patients before the Affordable Care Act kicks into overdrive in 2014.

In California, which pays one of the lowest Medicaid rates in the country, primary care physicians can expect to receive 136 percent higher reimbursements, according to the Kaiser Family Foundation.

The state Department of Health Care Services says it intends to eventually give higher payments to doctors for treating Medi-Cal clients, including retroactive payments for treatment after Jan. 1. DHCS blamed the delay on bureaucratic reviews that are not yet final, and it suggested other states also won't be able to pay immediately.

"Since the payment increase will be retroactive to January 1, 2013, any delay in implementation is not expected to impact a provider's willingness to continue serving Medi-Cal members," said DHCS spokesman Norman Williams in a statement.

Gov. Jerry Brown has suggested in recentdays that he may not embrace that expansion if it comes with higher state costs, though his argument appeared to be based on his own speculation that "fiscal cliff" negotiations may lead to a dramatic rollback in the Affordable Care Act.

December 13, 2012

The U.S. Court of Appeals for the 9th Circuit ruled today that California can cut rates to doctors, pharmacists and other providers for serving Medi-Cal patients, overturning a lower court decision that blocked a state budget cut from last year.

A three-judge appeals court panel determined that U.S. Health and Human Services Secretary Kathleen Sebelius has authority to determine whether California and other states can cut Medicaid rates -- the federal program of which Medi-Cal is part -- and still comply with the program's rules.

"The Medicaid program is a colossal undertaking, jointly funded by the federal government and the States," the 9th Circuit panel wrote. "Congress explicitly granted the Secretary authority to determine whether a State's Medicaid plan complies with federal law."

Sebelius approved California's cuts in October 2011, but U.S. District Court Judge Christina A. Snyder blocked them in December of last year. At the time, the cuts were expected to save $623 million annually.

California appealed the decision, and the 9th Circuit ruled in the state's favor today. It remains to be seen whether California will follow through with a 10 percent reduction to provider rates, and when that might occur.

Lynn S. Carman, who represents pharmacists as chief counsel for the Medicaid Defense Fund, said plaintiffs plan to ask the court for en banc review, meaning the full 9th Circuit bench would reconsider today's decision. If that is denied or the review does not block the rate cuts, Carman said his side would ask the U.S. Supreme Court to consider the case.

October 24, 2012

California, the nation's most populous state, also has the nation's largest number of medically uninsured children, but has lowered that number sharply in recent years, according to a new study by Georgetown University's Health Policy Institute.

Ironically, however, the study attributes that decline from 2009 to 2011, in part, to the state's Healthy Families program, which was repealed this year as part of the 2012-13 state budget, saving $13 million. Children who had been insured under Healthy Families are now being shifted into the Medi-Cal program, a move that has angered children's health advocates.

Georgetown's Center for Children and Families calculates that the number of medically uninsured California children dropped from 890,998 in 2009 to 744,797 in 2011 and the proportion from 9.5 percent of the state's children to 8 percent, just slightly above the national rate of 7.5 percent.

The 2011 rates ranged from a high of 16.2 percent in Nevada to a low of 1.7 percent in Massachusetts, the latter reflecting the universal health insurance program instituted by the state's former governor, Mitt Romney, now the Republican candidate for president. California's 8 percent rate was the 35th highest among the states.

July 9, 2012

An upcoming U.S. House of Representatives vote to repeal the federal health care law is fueling a new round of political ads in a heated East Sacramento County congressional race.

House Republicans announced plans for vote shortly after the U.S. Supreme Court upheld the 2010 law backed by President Barack Obama. The Wednesday vote is seen largely as a political maneuver meant to energize voters opposed to the law, as any effort to repeal the health care overhaul has no chance of passing the Democrat-controlled Senate.

But supporters of the law are also seeking to capitalize on the effort in the 7th Congressional District, where Democrat Ami Bera is challenging Rep. Dan Lungren, R-Gold River, for the second time.

The Democratic Congressional Campaign Committee launched a series of robocalls to independent voters last week, alleging that the Gold River Republican "wants to put insurance companies back in charge of our health care" by getting rid of the law. It followed up this week with a paid Web ad on YouTube highlighting provisions mandating preventative care and coverage for preexisting conditions that would be eliminated if that law is repealed.

Meanwhile, the American Action Network, a nonprofit advocacy group that does not have to disclose its donors, announced that it is sending voters in the district a mail piece urging Lungren to continue to fight for repeal. The group, which is spending $1.2 million on an "issue advocacy" campaign calling for repeal across the country, also ran an ad in Sunday's edition of The Sacramento Bee.

"The Supreme Court has upheld Obamacare. Congress has only one option: Repeal the President's government takeover of your healthcare," read both pieces, which contend the law will lead to new taxes and cuts to Medicare.

June 28, 2012

The Brown administration said today that it is rapidly moving ahead on California's health care expansion following the U.S. Supreme Court ruling upholding President Barack Obama's signature law.

"This is a very great day," state Health and Human Services Secretary Diana Dooley said. "California has been a leader in health care reform for a very long time. We've had many starts and stops, and we are now in the full go mode here."

At stake for California was billions of dollars in federal aid for the state's expansion of coverage.

Under the Affordable Care Act, the state is expected to receive $45 billion to $55 billion from the federal government from 2014 to 2019 to expand Medi-Cal, California's version of Medicaid. An additional 1.2 million to 1.6 million Californians are expected to be newly covered under the program.

In addition, through the California Health Benefit Exchange, a public health insurance marketplace prescribed by the federal overhaul, officials estimate about 2 million Californians -- many of them currently uninsured -- will obtain insurance beginning in 2014.

"This ruling removes a distraction from the job that thousands of Californians have come together to address," said Peter Lee, the exchange's executive director.

Lee said the state is "moving full-speed ahead" to establish the exchange, including a "major media and outreach campaign" next year.

"We look forward to making the purchase of insurance through California's exchange as easy as buying a book on Amazon or shoes on Zappos," Lee said.

Gov. Jerry Brown was among state Democrats celebrating the ruling. He said in a prepared statement, "Today's dramatic Supreme Court ruling removes the last roadblock to fulfilling President Obama's historic plan to bring health care to millions of uninsured citizens."

A collection of statements and responses from California officials and groups is posted after the jump. You can send your statement to hmadans@sacbee.com. Read more coverage of the decision at SacBee.com.

June 27, 2012

There's still one potential November ballot measure pending - one that would subject health insurance rates to state regulation - and with only hours before the qualification deadline, its fate is up in the air.

Santa Monica-based Consumer Watchdog, a veteran of several high-profile ballot measure battles, and sponsored the initiative measure after the Legislature blocked a rate regulation bill that Insurance Commissioner Dave Jones had sought.

Consumer Watchdog submitted more than 800,000 signatures in May, and midnight Thursday is the deadline for counties to report whether validation sampling indicates that a full count would generate the 504,760 registered voter signatures needed to qualify. If it doesn't make it, the measure will proceed to a full signature validation count, but even if successful would not appear on the ballot until 2014.

To date, validation is running just under 70 percent and it would have to maintain that level, assuming all counties complete their processing, to make it to the ballot this year.

It all hinges on Los Angeles County, which has yet to submit any validation data. "It's going to be close," Jamie Court, Consumer Watchdog's president, said Wednesday.

If the measure qualifies, it will spark a multi-million-dollar shootout pitting Court's organization and its allies, including labor unions, against the huge health care insurance industry, medical care providers and business groups.

Twelve measures have already qualified for the ballot, including two high-profile tax increase measures, but the Legislature may remove an $11 billion water bond it had placed before voters.

June 13, 2012

U.S. Surgeon General Regina Benjamin was in Sacramento on Wednesday to talk up wellness.

About 70 California health advocates and others were on hand at the California Museum as Benjamin unveiled the National Prevention Council's new action plan aimed at helping all Americans stay healthy at all stages of life.

"Health does not occur in the doctor's office or hospitals alone," Benjamin told them. "It also occurs where we work, where we learn, where we play."

All 17 federal departments and agencies on the council will be combining efforts for the first time to reach goals such as increasing tobacco-free environments as well as access to healthy, affordable foods. Benjamin also pointed to the Environmental Protection Agency's work on enforcing the Clear Air Act and preventing asthma.

The plan, which complements efforts already under way, is meant to tackle obesity, tobacco use, health disparities among population groups, chronic disease and other issues. It stresses empowering people themselves, encouraging healthy and safe community environments, increasing preventive services and eliminating health disparities among population groups.

After Benjamin spoke, panelists discussed the importance of getting healthy lunches in schools and eliminating health disparities so people of color are not more likely to be obese or have chronic conditions than the population as a whole.

Others stressed the importance of youth in any health movement.

"We see young people not as a problem," said Olis Simmons, the founder of the Oakland's Youth UpRising. "We see young people as our partners in changing the community."

April 11, 2012

Republican U.S. Senate candidate Elizabeth Emken this week defended her work lobbying to include autism coverage in the federal health care overhaul backed by President Barack Obama in 2009, even though she opposed the bill.

Emken, one of 23 candidates challenging Democratic U.S. Sen. Dianne Feinstein on the June 5 ballot, has come under fire from Republican opponents over records showing Autism Speaks sought to influence the outcome of the legislation when she was listed as a top lobbyist for the nonprofit advocacy group.

The Danville Republican, whose 19-year-old son is autistic, said the organization lobbied lawmakers to include language to ensure that health care companies would provide coverage for medical issues and treatment related to the condition under the new law.

Emken said that while she disagrees with the overall approach of the health care overhaul, the effort to include the language was important for her and the organization because autism is "perfect example of a catastrophic medical event" that some insurance companies will not cover.

"What we were doing is, as everyone was doing when you have a Democratically-controlled Senate, House and president, everyone, Democrats and Republicans are all working on a piece of legislation that's on the table," she said during a Sacramento press availability Tuesday. "That's how it's done. You don't just walk away if you don't like how things are going. You continue to work on it."

Emken said the reference to autism did not make it into the bill, which was signed into law in 2010, and regulatory language emerging on the issue is "extremely nebulous." She said that outcome reinforced her opposition to the law.

"The issues are so long and vast and broad with Obamacare," she said, "I really believe the only solution is to repeal it, but I do believe in replacing it with real health care reform and real health insurance reform."

Emken dismissed the attacks from opponents, saying they are "to be expected" because she won the endorsement of the California Republican Party.

"As you can imagine, it's very natural that I'm sure the other Democratic candidates are going to be making comments about Dianne Feinstein and (Republicans are) going to be making comments about me and they're going to be unified in that because I have the support of the California Republican Party," she said.

PHOTO CREDIT: Republican candidate for U.S. Senate, Elizabeth Emken speaks at a news conference in Sacramento on April 10, 2012. Associated Press/Rich Pedroncelli

March 1, 2012

A tentative winner has been announced for a $900,000 public relations contract to help California implement federal health care reform: Sacramento's Ogilvy Public Relations Worldwide .

Ogilvy was chosen this week by the California Health Benefit Exchange to create a statewide marketing, outreach and education strategy designed to help reduce the number of Californians lacking health insurance.

The state exchange is charged with creating a new insurance marketplace for individuals and small business to buy competitively priced health plans beginning in 2014.

The contract is considered a plum of California state public relations contracts partly because the winner of the initial $900,000 pact, through October 2013, will be in key position to obtain a subsequent contract that could total tens of millions of dollars to launch the exchange.

The PR powerhouse made headlines earlier this year for quitting a $9 million contract with the state's high-speed rail authority.

In a letter to rail officials, Ogilvy said that it was "unable to develop a solid working relationship with your agency, and that impeded the kind of top-notch work we are accustomed to providing our clients."

August 30, 2011

The most contentious bill in the 2011 legislative session's final days would subject the multibillion-dollar health insurance industry to state rate regulation -- and it's spawned a boatload of campaign contributions, according to a new compilation.

Assembly Bill 52 is now pending on the Senate floor after clearing the Assembly on a 45-28 party-line vote, with Democrats in favor and Republicans opposed. Carried by Assemblyman Mike Feuer, D-Los Angeles, and sponsored by Insurance Commissioner Dave Jones, the measure also enjoys support from consumer activists, labor unions and other Democrat-friendly groups, while it's opposed by the health insurance industry and business groups.

Maplight, an organization that tracks campaign contributions and ties them to specific issues, says in its report that advocates of the measure have contributed nearly three times as much money to state senators as its opponents.

The Senate outcome is uncertain, even though Democrats could pass it without Republican votes, because it's also drawn opposition from local governments, pension funds and Gov. Jerry Brown's administration, the latter citing costs of implementation.

Advocates say that the measure would protect health care consumers from being gouged, especially in light of the federal government's new mandatory coverage law.

Maplight says that advocates of the measure have contributed $1.3 million in the last three years to senators who will be voting for or against the bill while opponents have given $455,000. The contrast was especially evident among senators who voted on the bill in the Senate Appropriations Committee last week, Maplight said.

It should be noted, however, that the groups weighing in on AB 52 typically have other issues pending before the Legislature, and the pro-AB 52 groups historically support Democrats, while those opposed are more likely to support Republicans.

August 25, 2011

The state's new health benefit marketplace, an instrumental arm of the 2010 federal health care overhaul, will announce today that it has tapped an Obama administration official as its first executive director.

Peter V. Lee, deputy director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services, will assume the California Health Benefit Exchange job on Oct. 17, 2011.

He will receive a salary of $250,000, more than the $173,987 that Gov. Jerry Brown receives.

Lee previously served from 2000 to 2008 as executive director and CEO of the Pacific Business Group on Health, a San Francisco-based nonprofit that seeks to leverage employer health care purchasing power. That role is similar to one that the exchange is expected to play on behalf of individuals and small businesses.

The California Health Benefit Exchange announced earlier this month that it had received a $39 million federal grant to lay groundwork over the next year. Under the 2010 federal health care law, state exchanges will negotiate with health plans to provide subsidized benefits to low- and middle-income individuals, as well as small businesses. The California program is expected to begin enrolling Californians in late 2013, with benefits starting in 2014.

The law is subject to legal challenge, principally over whether it is constitutional for the federal government to require individuals to carry health insurance. The U.S. Supreme Court is expected to eventually decide the matter.

August 18, 2011

The state Supreme Court handed insurers and business groups a major legal victory -- and personal injury lawyers an equally big setback -- on Thursday by imposing limits on medical damages in one of the era's closest watched civil cases.

The issue in the case, Howell v. Hamilton Meats & Provisions, was whether an injured party could collect the full medical care costs billed by doctors and hospitals, or the lesser amount that the medical providers accepted from an insurance company.

"In that circumstance, may the injured person recover from the tortfeasor, as economic damages for past medical expenses, the undiscounted sum stated in the provider's bill but never paid by or on behalf of the injured person? We hold no such recovery is allowed, for the simple reason that the injured plaintiff did not suffer any economic loss in that amount."

Insurers had said that if they had lost the case, it would add as much as $3 billion a year to their payouts in auto accidents and other personal injury cases. Plaintiffs' attorneys would have been entitled to about a third of that amount.

The case stemmed from a San Diego County collision in which Rebecca Howell was injured by a truck, driven by an employee of Hamilton Meats, which was making an illegal u-turn. Her medical bills totaled $190,000 but her health insurer settled the bills for $59,691 and the question was whether she would receive the full $190,000 from Hamilton's insurer.

Hamilton won at the trial level but lost at the appellate level. The case went to the state Supreme Court along with several other appellate decisions on the same issue, one of which was authored by Chief Justice Tani Cantil-Sakauye before her elevation last year to the Supreme Court.

However, Cantil-Sakauye in effect reversed herself by voting with five other justices that the payout should be limited to $59,691.

Joan Klein, an appellate court justice sitting on the Supreme Court for the Howell case, was the lone dissenter in Thursday's ruling. She agreed that the $190,000 was too much, but said the trial court should be empowered to decide what the proper amount should be.

August 12, 2011

California's new state marketplace for health insurance announced Friday that it has received a $39 million federal grant to launch major operations over the next year.

The California Health Benefit Exchange is part of the federal health care overhaul approved last year. Starting in 2014, the exchange is expected to provide new health insurance options to individuals and small businesses after negotiating rates with health plans.

Such rates are supposed to be more affordable for employers and individuals because the state would leverage its negotiating power for more than 1.5 million enrollees, while the federal government would provide subsidies and tax credits. But the five-member exchange board still has to sort out many questions, such as whether to focus more on price or quality of care, as well as how best to enroll individuals across a wide range of income levels.

The health exchange intends to use the grant toward its three-year business plan, as well as to hire a contractor to build its information technology platform.

June 2, 2011

The Assembly passed one of the year's most controversial and intensively lobbied bills Thursday -- imposing rate regulation on health insurers -- after Republicans walked out of the chamber in protest.

GOP members wanted to call a caucus to discuss the measure, Assembly Bill 52 by Assemblyman Mike Feuer, D-Los Angeles, but Speaker John A. Perez refused to call a recess. Democrats then defeated a recess motion with leaders saying Republicans were trying to stall long enough to kill the bill because of Friday's deadline for action.

The GOP retreated to the Rules Committee room off the chamber and closed the door.

Without Republicans on the floor, the remaining Democrats conducted a brief debate, with Feuer arguing that regulation by the insurance commissioner is needed because "health insurance rates are skyrocketing." Several Democrats were critical of the bill but just one, Sacramento's Richard Pan, voted against it as the measure was sent to the Senate on a 42-1 vote. Pan is a physician.

Health access groups and Insurance Commissioner Dave Jones, whose presence on the floor prior to the bill debate had irked Republicans, have lobbied for the bill while health insurers, backed by business groups, oppose it.

Republicans, meanwhile, ended their off-the-floor meeting about 30 minutes later, but were clearly still peeved about what they called unprecedented and disrespectful actions by their Democratic colleagues.

"I think you just saw the budget explode," said Assemblyman Kevin Jeffries, R-Lake Elsinore. "Over the stupidest reasons the Speaker has decided apparently to disrespect the Republican leader and the Republican caucus and I think there's going to be significant consequences for that."

Democrats shot back by pointing out that their colleagues returned shortly before Green Bay Packers quarterback Aaron Rodgers paid a visit to the floor to be honored by Assemblyman Dan Logue, R-Linda.

"The Republicans walked out on their job and on the consumers of California, but managed to come back to work 30 minutes later when it was time to get autographs from a famous football player," said Perez spokeswoman Robin Swanson.

March 23, 2011

Friends and foes of the federal health care overhaul are marking today's one-year anniversary of President Barack Obama signing the Patient Protection and Affordable Care Act into law.

Supporters of the federal health care law have planned events across the state to celebrate the law's first birthday. Lt. Gov. Gavin Newsom will be in Los Angeles this afternoon to tout the positive impacts that supporters say the changes are having on Californians, while Democratic Rep. Doris Matsui, Insurance Commissioner Dave Jones and Democratic Assemblyman Richard Pan, a pediatrician, are all scheduled to attend events in the Sacramento region.

"In just one year, hundreds of thousands of Californians have directly benefited from the passage of the Affordable Care Act," Anthony Wright, executive director of Health Access California said in a statement. "The law is making a difference, from the tens of thousands of young adults and those with pre-existing conditions taking advantage of new options for coverage, to the hundreds of thousands of seniors and small businesses getting direct help to afford coverage."

Meanwhile, opponents of the plan are marking the anniversary by pointing out shortcomings and renewing pledges to fight the law.

GOP Rep. Jeff Denham of Atwater issued a statement vowing to "continue to dismantle ObamaCare through more votes and hearings in the House in order to replace it with affordable solutions and common-sense reforms that protect jobs."

"The health care law forced through Congress by the Democrats and the President one year ago has completely failed to live up to the promises it made to the American people," Denham said in a statement blasting the law for increasing costs.

California Republican Party Chairman Tom Del Beccaro pointed to polls showing opposition to the law and cases in which federal judges deemed at least part of the plan unconstitutional.

"The 63 Democrats who lost their seats in November are the people who should be organizing a wake," Del Beccaro said in a statement. "Polls are now showing that most Americans want Obamacare repealed, 28 states are challenging the law in court, two federal courts have said it's unconstitutional, and the 1000+ waivers prove that this law has not achieved what it set out to do and is in fact a job-killer. If this keeps up, Obamacare's first anniversary might just be its last."

PHOTO CREDIT: President Barack Obama, surrounded by lawmakers and guests, signs the health care insurance reform legislation during a ceremony in the East Room of the White House in Washington on March 23, 2010. Saul Loeb/ AFP.

March 11, 2011

California's "well-being index" is just about average in a new nationwide survey measuring levels of healthy and happy living by the Gallup polling organization - but residents of the San Francisco Peninsula score the highest of any region in the nation.

It was the third year in a row that residents of California's affluent and bucolic 14th Congressional District scored the highest in the survey, which measured levels of diabetes, obesity, consumption of fresh produce, physical exercise, optimism and health insurance coverage.

Gallup surveyed more than 350,000 people nationwide to create its index and rankings by state and locality. The 14th Congressional District includes Redwood City, Palo Alto, Menlo Park, Mountain View and Los Altos and is represented by Democrat Anna Eshoo.

The nation's overall well-being index is 66.8 while California's score - 18th highest - is 67. Hawaii scored the highest at 71 while West Virginia is the lowest at 61.7. The full Gallup report can be found here.

February 2, 2011

Rep. Dan Lungren couldn't be blamed if his chest puffed up with pride just a little when President Barack Obama gave a shout-out to a bill of his during the State of the Union last week.

The measure -- which would repeal a provision of the health care reform law that has nothing to do with health care -- drew not a ton of attention or support when Lungren first introduced it last year.

Now, it is on the front burner of the new Republican leadership in the House (given the priority designation of House Resolution 4) and it has some 260 co-sponsors, including many Democrats. It appears likely that it will be the one part of the health care law that will be repealed.

Lungren told The Bee's editorial board this afternoon that he was "surprised, but pleased" that the president gave it a thumbs up during his speech.

January 31, 2011

PENSACOLA, Fla. - A federal judge in Florida says the Obama administration's health
overhaul is unconstitutional, siding with 26 states that had sued to block it.

U.S. District Judge Roger Vinson on Monday accepted without trial the states' argument
that the new law violates people's rights by forcing them to buy health insurance by 2014 or face penalties.

Attorneys for the administration had argued that the states did not have standing to
challenge the law and that the case should be dismissed.

The case is likely to go to the U.S. Supreme Court. Two other federal judges have
upheld the insurance requirement, but a federal judge in Virginia also ruled the insurance requirement unconstitutional.

January 20, 2011

The American Lung Association praises California for its laws barring smoking in public places, but otherwise gives the state low marks in its annual state-by-state survey of anti-smoking efforts.

California - like all but a few other states - was given an "F" for its spending on anti-smoking campaigns. The Centers for Disease Control says California should be spending nearly $442 million a year, but it spends only $89.7 million, all of which comes from cigarette taxes and federal allocations.

It also gets a "D" for its relatively low level of cigarette taxes, 87 cents a pack, and another "F" for its laws and regulations compelling health insurers to cover smoking cessation treatment. Nationwide, cigarette taxes range from $4.35 a pack in New York to 17 cents in Missouri.

The lung association is one of the sponsors of a ballot measure -- which could face voters as early as June -- that would would raise the tobacco tax by $1 a pack to fund cancer research and smoking prevention programs.

Overall, the ALA says, California has 235 annual deaths per 100,000 population attributed to smoking, roughly in the middle of the states. The lowest rate of smoking deaths is in Utah, 138.3, and the highest is in adjacent Nevada, 343.7.

December 16, 2010

As recession continues to grip the state, the number of Californians without health insurance, especially coverage provided by employers, has continued to climb, according to a new study by the California Healthcare Foundation.

Over the last two decades, the foundation says, Californians under 65 with employer-provided health insurance have dropped from 65 percent to 52 percent and "while increases in Medicaid (Medi-Cal) coverage partially offset this decline, more than 20 percent of Californians remained uninsured."

The state has the nation's highest number of uninsured, 6.8 million and one of its highest rates. The foundation, in its annual California Health Care Almanac, says 60 percent of Californians without health coverage are Latinos, and more than half of uninsured children are in families headed by full-time workers.

July 16, 2010

California's supply of physicians has been growing faster than its population in recent years and now matches the national ratio. While specialists abound, however, primary care physicians are in relatively short supply and the squeeze could increase as older doctors retire and demand for care increases under the new federal health plan.

So concludes a statistical report by the California Healthcare Foundation. "With large numbers of physicians nearing retirement," the foundation says, "and not all doctors taking patients with private or public insurance, those seeking care, especially in some regions, could have difficulty finding a provider."

Nearly 30 percent of California's physicians are 60 years or older, a higher percentage than any other state, the study found, and the state is increasingly dependent on foreign-trained physicians.

June 23, 2010

Los Angeles County has one of the nation's lowest rates of smoking. But after years of sharp decline, the rate has remained static for the past eight years, according to a new study by the county's health department.

L.A. County's 10-plus million residents are more than a quarter of the state's population and the new study says 14 percent of its non-children - more than a million persons - are smoking, including 12 percent of teenagers.

The county's smoking rate is virtually identical to California's statewide rate, which is the second lowest of any state. Utah is by far the lowest at less than 10 percent, while Kentucky, a tobacco-growing state, is highest at 28-plus percent. California has spent tens of millions of dollars, much of it raised from cigarette taxes, to persuade Californians to quit smoking.

The Los Angeles study found wide disparities in smoking rates among the county's geographic areas and ethnic groups.

Wealthy, mostly white and Asian-American San Marino had the county's lowest rate of smoking, 5.3 percent, while in Quartz Hill, due north of San Marino on the other side of the San Gabriel Mountains, it was 21.9 percent.

June 3, 2010

With one day left until the deadline for bills to pass out of the house of origin, expect a lot more action coming from both chambers.

The Senate has about 30 bills left to take up. Two Democratic members who have been absent due to medical conditions, Jenny Oropeza, who suffered from a blood clot, and Pat Wiggins, who has been unable to attend sessions because of an undisclosed medical condition, will be back on the floor to cast votes for the close calls.

And as usual, both houses are leaving some of the most controversial measures for last.

Chatting on cell phones (and texting third house friends) might be banned on the floor for lawmakers, but that won't stop senators from talking about laws affecting mobile users today.

May 13, 2010

As many as two million more low- and moderate-income Californians could become eligible for health care under the state's Medi-Cal program when the new federal health care program kicks in, the Legislature's budget analyst says.

Legislative Analyst Mac Taylor's office, in an analysis of the health care program, says that expanding Medi-Cal, which now serves 7.3 million persons, would be partially financed by federal funds but still drive up costs borne by California taxpayers.

How much that will cost is still uncertain, the LAO report says, but it "will put significant fiscal pressure on the state in the out-years, particularly as the enhanced federal funding is somewhat reduced."

Gov. Arnold Schwarzenegger was a sharp critic of the federal health care program when it was being written by President Barack Obama and a Democratic Congress, citing the potentially heavy impact on a state budget that's already gushing red ink. But after enactment, Schwarzenegger pledged to fully implement it in California.

The full LAO report on the program's impact on California is available here.

April 27, 2010

The ink is barely dry on the massive health-care overhaul signed into law by President Barack Obama last month, but Republican Rep. Dan Lungren is ready to do a little tinkering.

Lungren, of Gold River, introduced the Small Business Paperwork Mandate Elimination Act, which would scrap some reporting requirements contained in the legislation.

Under the new law, any business that purchases more than $600 of goods or services from another business must submit a 1099 tax form to the Internal Revenue Service. Lungren is proposing to remove that mandate, which is scheduled to take effect in 2012.

The 1099 is the IRS from the annual reporting of dividend and interest payments made to investors.

Lungren said large corporations have the personnel to handle such paperwork but that the requirement would hurt small businesses, serving as "yet another brick on their back."

"I am dumbfounded that this administration is doing all it can to make it more difficult for businesses to succeed rather than doing all it can to help them grow," Lungren said.

April 15, 2010

California could see a 27 percent increase in those receiving medical care under Medi-Cal, the federal-state program that serves low-income residents, under a major provision of the newly adopted overhaul of national health care, a new study has found.

But UnitedHealth Group also says that California could offset the higher costs and much more by upgrading its medical care delivery system. In fact, it could save 10 times as much as those extra costs, the Minneapolis-based managed care firm says.

As the largest state, California is expected to see the largest numerical growth in Medi-Cal enrollment, some 2 million, over the next nine years. But the 27 percent growth is actually below the national average of 32 percent, largely because California has a relatively large recipient base already, due to its relatively low threshold of qualifying for benefits. The program is called Medicaid in most states.

March 23, 2010

Both GOP gubernatorial candidates have joined California Republicans supporting a legal smackdown of the sweeping health care overhaul signed into law today.

Insurance Commissioner Steve Poizner launched the first strike yesterday, calling on Attorney General (and would-be rival) Jerry Brown to join the group of mostly Republican state attorneys general suing the federal government to repeal the bill.

"California is going to have an even harder time balancing the budget because of the new mandates placed upon us by the federal health care bill," Poizner said in a statement. "(More than 12) states have announced plans to challenge the constitutionality of Obamacare and given California's economic crisis, we cannot afford to let the federal government stick our state with billions more in unfunded mandates."

Whitman, too, opposes the legislation and supports the court challenges (as do all three Republicans running for U.S. Senate).

March 23, 2010

The ink has barely dried on the sweeping health care legislation signed into law today, but California Republican lawmakers have joined a chorus of critics calling for swift action to knock down the bill's big changes to the country's health care system.

"I think that many Californians share the same view that ... this is the greatest expansion of government in a generation and it is also the greatest intrusion into personal liberty and states rights that we have seen in many generations," Senate GOP leader Dennis Hollingsworth said at a press conference.

Arguing that Congress has violated the "Commerce Clause" of the Constitution by mandating that citizens obtain health coverage, the lawmakers urged Attorney General Jerry Brown to join more than a dozen attorneys general nationwide who have said they will sue the federal government challenging the constitutionality of the bill.

"The bill assumes that congressional power over the states, their citizens, and their consumers' everyday economic decision is vast and limitless -- a position that is constitutionally untenable, completely unprecedented and contradictory to fundamental principles of federalism and limited government," GOP Sen. Tom Harman wrote in a letter to Brown.

March 18, 2010

More than a third of California's adults and a nearly a sixth of its children suffer from chronic health conditions such as asthma, diabetes, high blood pressure, congestive heart failure or psychological distress, according to a new report from the California Healthcare Foundation.

The lengthy report, prepared by researchers at UCLA's Center for Health Policy Research, follows on another recent study indicating that California's ranks of the medically uninsured have grown sharply to more than 8 million persons. And both were issued as Congress considers President Barack Obama's historic overhaul of health coverage.

March 16, 2010

California's severe economic recession has sharply expanded the ranks of its medically uninsured residents, a new statistical study by UCLA's Center for Health Policy Research has found.

The study, based on enrollee data from private and public medical care programs, found that the uninsured under age 65 increased from 6.4 million in 2007 to 8.2 million last year, largely because of higher unemployment and cutbacks in employer-underwritten coverage. That's nearly a quarter of the under-65 population of the state.

"These estimates help us understand the scale of the damage inflicted on California over the last two years," Shana Alex Lavarreda, a co-author of the study, said in a statement. California has one of the nation's highest uninsured rates - a factor attributed to its seasonal and diverse economy - and because of its size has more uninsured residents than any other state

The study was released as Congress wrests with President Barack Obama's effort to expand coverage for the uninsured. California Gov. Arnold Schwarzenegger attempted several years ago to win legislative approval of a similar expansion of health coverage, but his measure died in the state Senate after approval by the Assembly. It was opposed by conservatives who disliked more government expansion and liberals who wanted a single-payer, government-operated program.

February 22, 2010

While Republican leaders in Washington are urging President Barack Obama to start from scratch on a health-care bill, California Gov. Arnold Schwarzenegger on Monday dismissed the idea as "bogus talk."

It marked the second day in a row that Schwarzenegger strayed from his party's positions.

On Sunday, he defended Obama's economic stimulus plan and chided elected officials, most of them Republicans, who oppose the overall stimulus but are quick to trumpet individual projects in their states that are paid for the stimulus.

Standing outside the White House after meeting privately with Obama on Monday, Schwarzenegger touted the economic stimulus plan yet again.

"I think the stimulus package has been very successful so far and I think California has benefitted tremendously," he said.

February 16, 2010

Weintraub, who left the Bee for the venture in October, wrote in an editor's note that the mission of www.HealthyCal.org is "to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected."

February 8, 2010

The Department of Health Care Services said today it may have breached the privacy of 49,352 state residents who receive adult day health care services from the state.

In a terse news release, the department said that letters it mailed a week ago to 49,352 beneficiaries wrongly included those patients' Social Security Number on address labels.

The Department said the incident took place Feb. 1. It was notified of the error on Feb. 4. It started to notify the 49,352 beneficiaries about the problem on Sunday.

"At this point, there is no evidence that unauthorized parties have acquired or accessed beneficiary personal information," the department said in a prepared statement. Officials said they regretted the incident.

On Saturday 6, the department said it began sending notification letters to beneficiaries alerting them to the security breach. The letter also advised beneficiaries how to protect themselves from identity theft by contacting the three credit reporting agencies and placing a fraud alert on their files.

January 11, 2010

Gov. Arnold Schwarzenegger suggested one more "trigger" alternative Monday if the federal government does not provide California with additional federal funds -- transferring undocumented immigrant prisoners to the federal government.

The Republican governor last week relied on getting $880 million in federal funds for undocumented inmates to help bridge the state's $19.9 billion deficit through June 2011. President Barack Obama proposed eliminating that funding altogether last year, and Congress plans to allocate not even half that amount for all 50 states.

"Why should we pay for it when it is the federal government that is having the lax policies on the borders, and is really in charge of immigration policies?" Schwarzenegger said Monday in Torrance during a press conference to promote his job creation plan. "So why should we pay for it? We just want to hand them over all those prisoners. You take them. If you don't want to pay us, you take the prisoners."

December 16, 2009

Former eBay honcho Meg Whitman continues to lead the two other Republican candidates for governor next year and trails presumptive Democratic nominee Jerry Brown by only a few points, a new poll by the Public Policy Institute of California has found.

Whitman's 32 percent support level among Republican voters is a big lead over either former Rep. Tom Campbell at 12 percent and state Insurance Commissioner Steve Poizner at 8 percent, but the highest proportion, 44 percent, are the undecided Republicans.

While Brown, a former two-term governor who is now state attorney general, leads all three Republicans among all voters in the survey, his support remains well below 50 percent. In a theoretical matchup with Whitman, Brown leads 43 percent to 37 percent. His margins against Campbell and Poizner are considerably wider.

While all that is interesting to political junkies, however, most Californians still haven't focused on who they may want to succeed Republican Arnold Schwarzenegger next year.

"Voters have more immediate concerns than who is going to be the next governor," PPIC's president, Mark Baldassare, said in a statement analyzing the poll results. "Despite all the advertising in this early stage of the campaign, Republican primary voters are more likely to say they are undecided than to favor one of the three GOP candidates. At the same time, the Democrats' likely candidate falls short of majority support when matched up against the Republican contenders."

Whitman has spent heavily from her personal fortune on consulting advice and advertising, but has refused to debate the other two Republicans and almost never talks to California political reporters. Poizner, also a wealthy former Silicon Valley executive, has just committed $15 million more to his campaign while Campbell has scant personal or political resources.

The PPIC poll covered a wide variety of issues, finding that Californians remain very concerned about the state's recession-wracked economy (61 percent say it's the top issue facing the state), that President Barack Obama still enjoys high approval ratings (61 percent), that barely half (52 percent) support Obama's health care plans and that Schwarzenegger and the Legislature continue to have record-low approval ratings.

The full poll, including early takes on 2010 ballot measures, is accessible here.

December 15, 2009

The cost of health insurance provided by California employers has risen five times as fast as overall inflation since 2002, according to a new survey by the California HealthCare Foundation.

Health insurance premiums increased by 117.5 percent during the period, says the California Employer Health Benefits Survey, while the state's overall cost of living rate was 23.1 percent, including a 7.5 percent gain in the last year.

The survey also found that employers are shifting some of the added costs to their workers and/or shifting to less extensive coverage. This year, for instance, more than 20 percent of covered workers in small firms had deductibles of $1,000 or more, three times as many as in 2002.

Finally, the survey revealed that six percent of employers say they are "very likely" to drop coverage completely, up from 1 percent in 2008, 27 percent say they are likely to increase employees' co-insurance and co-pay burdens, and 44 percent of large employers and 20 percent of small ones say they are "very likely" to increase employees' share of insurance costs.

November 17, 2009

California, for the second straight year, has received a "C" grade by the March of Dimes for its premature birthrate - but that's not as bad as it sounds.

No state received an "A" grade on programs to prevent premature births. Only one, Vermont, got a "B," while the nation as a whole earned only a "D" grade.

California's premature birthrate, 10.9 percent of live births, is up slightly from 10.7 in 2008, and is still markedly lower than the national rate of 12.7 percent. The March of Dimes goal is 7.6 percent.

"While we are working diligently to fight growing rates of premature birth, our state's grade indicates that more needs to be done to give these babies a chance at a healthy start in life," said Dani Montague, director of the March of Dimes California chapter. "Nearly 58,000 babies are born too soon in California every year, and many of these births result in ongoing health problems and months of hospitalization for these tiny newborns."

Seven states improved their scores by one letter grade and two states declined. The March of Dimes recommends that states attack premature births, the leading cause of infant deaths, through such programs as reducing smoking among women of childbearing age and improving access to prenatal medical care.

An interactive map of the United States is available here while the detailed report on California can be found here.

November 10, 2009

California expanded health insurance for children earlier in this decade, reducing the uninsured ranks by 12 percent, but additional progress has been stalled by the state's chronic budget deficit, according to a new statistical report by the California Healthcare Foundation, and coverage declined in 2008.

Reductions in Healthy Families and other programs aimed at working poor families lacking health insurance has been a major issue as Gov. Arnold Schwarzenegger and legislators deal with its ongoing fiscal crisis.

Just last month, Schwarzenegger signed an emergency bill under which hospitals agreed to pay
$2 billion in fees to the state to qualify California for $2.3 billion in new matching money to hospitals and boost funding for children's insurance by $320 million and public hospital financing by another $310 million.

The Healthcare Foundation report says that expanding children's coverage dropped the state's uninsured rate to just above the national average of 11 percent, even though 80 percent of California's children are eligible for public programs.

It also notes that California's proportion of uninsured school children, 32 percent, is also slightly above the national average, and that as private employers cut back on employees' insurance, more children are being shifted to public programs.

October 27, 2009

Gov. Arnold Schwarzenegger wrote in a letter to Congressional leaders today that while he still supports passing a sweeping overhaul of the nation's health care system, he's worried about the cost the implementation of the plan could have on California.

As Rob Hotakainen reports from Washington, one of the governor's central concerns is a proposed Medicaid expansion.

Sounding more like a Democrat than a Republican, the governor said Congress should pass a plan "quickly, thoughtfully and, most important, successfully." And he said health care should not be a partisan issue, as it has become in Washington. ...

But unless Congress pays for all of its costs, Schwarzenegger said a mandatory expansion of Medicaid "will only be an empty promise of health insurance coverage" and will force California and other states to make cuts in education, public safety and elsewhere.

October 20, 2009

The sharp spike in California's unemployment rate - it's now over 12 percent of the labor force - means an equally sharp spike in the number of Californians who have lost their health insurance, a new report by Families USA, a Washington-based advocate for universal health care, concludes.

Families USA's report, issued today, estimates that California's medically uninsured population, one of the nation's highest, jumped by 661,600 persons this year to more than 6 million - by far the largest numerical increase of any state and one of the highest proportionate increases.

October 5, 2009

Democratic Rep. Mike Honda of California took offense last week when Republican Minority Leader John Boehner of Ohio compared the public insurance option to a "garlic milkshake," Roll Call reports today.

Honda supports both the public option and garlic. His district includes the city of Gilroy, which hosts a garlic festival each year.

On Friday, Honda delivered a basket of garlic to Boehner's office. The minority leader's staff accepted the gift.

September 17, 2009

GOP gubernatorial hopeful Tom Campbell released a unique health care proposal Thursday that would redistribute $42 billion in federal and state funds already spent on health care in California to buy private health coverage for everyone in the state who's "involuntarily" uninsured.

Under the former congressman's plan, the funds would cover an estimated 2 million such people in addition to the 7.6 million already receiving public health coverage under the state Medi-Cal and Healthy Families programs.

"The astounding conclusion," Campbell writes in his proposal, "is that, using only the money already being spent by the federal and state governments for health care in California, we could buy free market health insurance currently available and cover all involuntarily uninsured in California, and still have more than $700 per person left over!"

Campbell suggested the state launch its own plan "in the event that the federal effort does not produce meaningful reform."

His plan would let private insurers bid against each other for a fixed pot of money to cover everyone in a "relevant geographic region" who earned below a certain amount or who had been denied coverage by two private insurers because of a pre-existing medical condition.

To implement the plan, however, the state would have to win a federal waiver allowing it to use federal funds in such a way, and the federal government would have to repeal the antitrust exemption for insurance companies and also pass laws allowing the interstate sale of insurance plans.

August 31, 2009

California has one of the nation's highest proportion of residents without medical insurance, about 20 percent, but many of those with insurance have found themselves with debts from medical care, according to a new study by UCLA's Center for Health Policy Research.

More than 2.2 million adults Californians report medical debt, with two-thirds of them incurring debt while insured, according to "The State of Health Insurance in California." Overall, 13 percent of Californians have some kind of medical debt and about a third of those have more than $2,000 in medical debt.

Not surprisingly, residents of relatively low-income rural areas have the greatest levels of medical debt, as high as 39 percent in Humboldt County, while those in affluent urban areas have few such problems, just 7.1 percent in San Mateo County.

"That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance," said E. Richard Brown, director of the UCLA center. "Current policies either do not offer enough coverage or offer full-coverage at a cost that is too expensive for many people to bear. The result is that too many people have health insurance plans that leave them financially vulnerable and force them to delay the care they need."

The full report on Californians' health insurance, or lack thereof, is available here.

August 13, 2009

Children's health care advocates got both a boost and a blow today, as the California First 5 Commission announced it would contribute $81.4 million to the state's Healthy Families health insurance program.

But members of the Managed Risk Medical Insurance Board, which runs Healthy Families, still had to tell the program's administrators to begin disenrolling children Oct. 1 to help close a funding shortfall.

"It was a day of very good news and very bad news for kids," said Wendy Lazarus, founder of Children's Partnership, a nonprofit child advocacy organization. "I think the First 5 contribution shows tremendous leadership."

"(But) this is a really dark, grim situation for kids in California," Lazarus said. "I don't think anyone living here ever thought we would see a day where kids with very low income can't get heath care."

The 12-year-old program provides low-cost insurance to about 900,000 children and teens in low-income families that aren't poor enough to qualify for Medi-Cal. Adults in many of the families are working, but their jobs don't provide health coverage or don't cover dependents.

The Legislature reduced the Healthy Families budget by $128.6 million in its budget revision last month, and Gov. Arnold Schwarzenegger used his line-item veto to cut $50 million more.

August 12, 2009

The Bee political cartoonist Rex Babin sketches his take on the health care town halls going on across the country. What do you think about the town halls and Babin's cartoon? Let us know in the comments forum.

June 29, 2009

The Service Employees International Union's state council today endorsed LT. Gov. John Garamendi to represent California's 10th District in the U.S. Congress.

The powerful union umbrella group said it's backing Garamendi because he's a "champion for universal health care, higher education, and economic opportunity."

SEIU state council executive director Courtni Pugh cited Garamendi's "lifelong support for working families," displayed when he was first a California legislator (1974-1988), then twice as insurance commissioner and now lieutenant governor.

The 10th District seat will soon be up for grabs in a special election triggered by the appointment of current Rep. Ellen Tauscher, a veteran Democrat, as undersecretary of state for arms control and international security. The Senate approved Tauscher's appointment last week.

The 10th District district stretches from San Francisco's east bay area to the Sacramento-San Joaquin Delta.

The SEIU says it has more than 700,000 state and local government members across California who work in all 58 counties, including social workers, nurses, classroom aides, security officers, college professors, homecare workers, and janitors.